胸骨后甲状腺的诊断和治疗──65例报道  

DIAGNOSIS AND MANAGEMENT OF SUBSTERNAL GOITERS

作　　者：仇德惠[1] 曾亮[1] 徐正浪[1] 郑如恒[1] 石美鑫[1] 徐松涛 乔玉磊[1] 

机构地区：[1]上海医科大学中山医院普胸外科

出　　处：《上海医学》1996年第2期70-72,共3页Shanghai Medical Journal

摘　　要：本文复习了中山医院普胸外科４０年间６５例胸骨后甲状腺病例，良性５６例（８６．２％），恶性９例（１３．８％）。其中术前误诊２例，分别误诊为纵隔畸胎瘤和肺癌。治疗采用切除胸内甲状腺和病变的甲状腺，如为甲状腺癌，施行甲状腺全切除并清扫颈淋巴结。手术效果满意，无手术死亡率，良性病变术后症状明显改善，恶性者术后平均生存２年以上。手术切除６３例，其中４１例采用颈低位横切口，坠入胸腔较深或有粘连时可加作前胸切口。其它根据情况还可选用附加胸骨正中劈开、颈部胸骨劈开。前胸联合切口、合并胸壁切除及重建等。e reviewed the cases of 65 patients with substernal goiters during a forty-year period1954～1993.The mean age of 23 men and 42 women was 54 years. Fifty-six(86.2%)goi-ters were benign and nine(13.8%)malignant.The most common symptoms included a neckmass and dysphagia. Symptoms of chest pain,hoarseness and superior vena cava syndromehad a significant probability of being malignant.Twenty-one patients were asymptomatic.Diagnosis was easily done by symptom,physical examination and chest film. Planar imagineusing131I had the value of confirming the diagnosis,Computed tomography could be usedto help define the adjacent organ involvement.Magnetic resonance imaging,vena cava supe-rior angiography and retrograde aorta angiography help define the vascular involvement.Ul-trasonic waves examination helped define the size and nature of the goiters. A preoperativeincorrect diagnosis of teratoid tumor and lung cancer was made in two cases,Treatment canbe made by excision of intrathoracic goiters. There were no post-operative death.Sixty fivepatients accepted surgical operation;Forty-one patients underwent transcervical approach forresecticn. Six patients required a cervical incision plus anterior thoracotomy,four plus medi-an sternotomy,Five patients accepted a cervical-median sternotomy-anterior thoracotomy in-cision. An anterior-lateral thoracotomy was used in six cases,re-constructure of chest wallin 3 cases.

关 键 词：胸骨后 甲状腺 甲状腺切除术 

分 类 号：R653[医药卫生—外科学]