临床研究(Clinical Research)

颈部入路切除胸骨后甲状腺肿57例临床分析

Published at: 2017年第26卷第3期

蒋波 1 , 彭瑶 1 , 王浩 1 , 张哲嘉 1 , 冯铁诚 1 , 李劲东 1 , 谭辉 1 , 王志明 1 , 李新营 1
1 中南大学湘雅医院 普通外科甲状腺专科,湖南 长沙 410008
通讯作者 志明 王 Email: 13808462382@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.03.012
基金:
国家自然科学基金资助项目 81672885

摘要

目的:探讨经颈部入路切除胸骨后甲状腺肿的适应证和手术技巧。方法:回顾性分析2013年1月—2016年9月经颈部入路切除胸骨后甲状腺肿的57例患者资料和手术结果。结果:57例患者(包括2例异位胸骨后甲状腺肿)中,22例无明显临床症状,35例表现为呼吸困难、吞咽不适和声嘶等压迫症状;根据Randolph分型,I、IIA、IIB、III型分别为34、16、5、2例,根据CT分级,1、2、3级分别为30、18、9例。患者均经单纯颈部入路切除,其中6例(10.5%)为再次甲状腺肿手术。病理结果显示49例为良性,8例为分化型甲状腺癌。术后并发症包括暂时性声带麻痹1例(1.8%)和暂时性低钙血症5例(8.8%)。结论:经充分的术前评估,大多数胸骨后甲状腺肿经颈部入路切除是安全可行的。熟练的操作技巧、术者丰富的经验和具备开胸条件是手术成功的关键和前提保证。


Excision of substernal goiter via cervical approach: a clinical analysis of 57 cases

Abstract

Objective: To investigate the indications and the surgical techniques for excision of substernal goiter via cervical approach. Methods: The clinical data and surgical results of 57 patients with substernal goiters undergoing surgical excision through cervical approach from January 2013 to September 2016 were retrospectively analyzed. Results: Of the 57 patients (including 2 cases of ectopic goiters), 22 cases had no obvious clinical symptoms and the other 35 cases presented with compression symptoms such as dyspnea, dysphagia and hoarseness; the lesions were classified according to Randolph’s criteria as type I in 34 cases, type IIA in 16 cases, type IIB in 5 cases and type III in 2 cases, and based on CT classification as grade 1 in 30 cases, grade 2 in 18 cases and grade 3 in 9 cases, respectively. Cervical approach thyroidectomy was performed in all these patients, including repeat thyroid surgery in 6 cases (10.5%). There were benign diseases in 49 patients and differentiated thyroid cancers in 8 patients as evidenced by pathological findings. Postoperative complications included temporary vocal cord paralysis in one case (1.8%) and temporary hypocalcemia in 5 cases (8.8%). Conclusion: The majority of substernal goiters can be safely excised through cervical approach after thorough preoperative assessment. Excellent surgical skills, operation by experienced surgeons and readily accessible thoracotomy set are the premises and critical to surgical success.


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引用

引用本文: 波 蒋, 瑶 彭, 浩 王, 哲嘉 张, 铁诚 冯, 劲东 李, 辉 谭, 志明 王, 新营 李. 颈部入路切除胸骨后甲状腺肿57例临床分析 [J]. 中国普通外科杂志, 2017, 26(3): 347-351.
Cite this article as: JIANG Bo, PENG Yao, WANG Hao, ZHANG Zhejia, FENG Tiecheng, LI Jingdong, TAN Hui, WANG Zhiming, LI Xinying . Excision of substernal goiter via cervical approach: a clinical analysis of 57 cases [J]. Chin J Gen Surg, 2017, 26(3): 347-351.