巨大甲状腺肿合并气管软化的诊断与治疗  

Diagnosis and management of tracheomalacia in patients with large goiter

作　　者：袁时芳[1] 黄育勉[1] 王岭[1] 凌瑞[1] 姚青[1] 马中[1] 

机构地区：[1]第四军医大学西京医院血管内分泌外科,西安710033

出　　处：《中华普通外科杂志》2006年第9期647-649,共3页Chinese Journal of General Surgery

摘　　要：目的探讨巨大甲状腺肿合并气管软化的诊断及手术治疗。方法回顾性分析1992-2004年本院收治的36例巨大甲状腺肿合并气管软化的临床资料。所有病例均在术前行瓦-米试验摄片。甲状腺切除术后行气管悬吊,其中2例加行气管切开。结果患者的瓦-米试验均阳性。术中探查:局部受压处气管软骨环消失2例,气管软骨环变细、变薄、变软34例。34例甲状腺切除术后行单一气管悬吊患者获得临床治愈。2例气管悬吊加气管切开患者抢救成功。无手术死亡。32例获随访,随访时间6个月至13年,30例均无呼吸道梗阻症状,2例死于与手术无关的疾病。结论巨大甲状腺肿合并气管软化的诊断有赖于瓦-米试验和术中探查。甲状腺切除术后气管悬吊是治疗巨大甲状腺肿合并气管软化的有效方法。Objective To discuss the diagnosis and management of tracheomalacia complicating large goiter. Methods Clinical data of 36 patients with large goiter complicated by tracheomalacia at Xijing Hospital between 1992 and 2004 were retrospectively reviewed. Preoperative Valsalva-Mueller test were performed in all patients before undergoing subtotal thyroidectomy with tracheal suspension, and two patients were treated by subtotal thyroidectomy with tracheal suspension and tracheostomy. Results Valsalva-Mueller test was positive in all patients. The compressed tracheal cartilage disappeared in 2 cases, became thin and soft in other 34 cases. Thirty-four patients who underwent subtotal thyroidectomy with tracheal suspension recovered and 2 patients were resued by tracheal suspension with tracheostomy. There was no mortality. Postoperative 34 cases were followed-up from 6 months to 13 years. Thirty-two cases had no postoperative respiratory obstruction, 2 patients died of unrelated diseases. Conclusions The diagnosis of tracheomalacia from large goiter is based on Valsalva-Mueller test and operative detection. Subtotal thyroidectomy with tracheal suspension is the treatment of choice for tracheomalacia complicating large goiter.

关 键 词：甲状腺肿 甲状腺切除术 气管悬吊术 

分 类 号：R653[医药卫生—外科学]