后纵隔甲状腺肿物经颈部切口切除及手术适应证的探讨  

Discussion about cervical incision of goiter in mediastinum posterior and it's indications

作　　者：王占龙[1] 赵岩[1] 周长华[2] 李如迅[3] 吴干勋[1] 赵瑞力[1] 胡俊兰[1] 陈新[4] 周维安[1] 

机构地区：[1]河北医科大学第四医院暨河北省肿瘤医院耳鼻咽喉-头颈外科,石家庄050011 [2]定州市人民医院耳鼻咽喉-头颈外科 [3]河北医科大学第四医院暨河北省肿瘤医院CT室 [4]河北医科大学第四医院暨河北省肿瘤医院胸外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2008年第18期817-819,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨经颈部切口切除后纵隔甲状腺肿物的可能性。方法:根据甲状腺肿物坠入后纵隔的形成机制以及甲状腺和纵隔的手术解剖,设计手术原则:①自上而下的手术原则;②自喉返神经入喉处寻找并解剖喉返神经,找到喉返神经后,尽量长的解剖喉返神经保护之,避免术中损伤,同时可沿喉返神经寻找甲状腺血管;③为避免手术中出现不可控制的大出血,在手术进入胸腔以前,必须处理结扎甲状腺在颈部所有正常或变异的血管,避免对胸部大血管的牵拉;④在外科被膜下,钝性分离胸部肿物,大多可避免损伤重要结构;⑤当胸部肿物与周围结构粘连不易分离时,请胸外科医师协助解决困难。结果:2例手术成功实施,效果满意,对患者创伤小,恢复快,医疗费用低。结论:经颈部切除后纵隔甲状腺肿物是一理想的手术方法,但有其适应证:①影像学资料提示后纵隔肿物与周围结构无粘连;②不伴有上腔静脉压迫体征;③巨大后纵隔甲状腺肿物,可采取取出肿物部分中央组织(对中央组织液化者尤其适用),缩小肿物,然后自颈部取出,如若困难不能取出,则请胸外科医师开胸帮助解决。Objective： To explore the feasibility of cervical approach for goiter in posterior mediastinum. Method：According to the mechanism that goiter felled into posterior mediastinum and the dissection of thyroid gland and mediastinum, we designed the following surgery principles （1）From top to bottom. （2）Find out recurrent nerve at the place where it enters larynx, then dissect recurrent nerve as long as possible and protect it carefully, meanwhile, search thyroid vessels along recurrent nerve. （3）To avoid and uncontrollable serious hemorrhage in the operation, all normal and aberrant blood vessels must be ligated cautiously, and avoid pulling great vessels in the thoracic part. （4）Separating tumor of hemorrhage under surgical capsule Bluntly, it can avoid damage important structure in most occasions. （5）If the tumor of hemorrhage was difficult to be separated from the surrounding structure, ask thoracic surgeon for cooperation. Result：Two operations case were operated under the above guideline successfully, and the operations were performed with satisfactory effect ,minimal invasion, rapid recovery and low medical costt. Conclusion：Cervical approach for goiter in mediastinum posterior is an ideal method of surgery, but it has following operative indication. （1）imaging date indicate that tumor of posterior septum is not connected to the surrounding structure. （2）It is not accompanied with superior vena cava sydrome. （3）The size of large thyroid tumor of posterior septum could be decreased by taking out the center part of tumor, and it is suitable for liquidized cen- ter tissue especially, then take out the tumor from neck. If it is hard to be taken out, you can ask thoracic surgeon for help.

关 键 词：外科手术 甲状腺肿物 后纵隔 颈部切口 手术适应证 

分 类 号：R61[医药卫生—外科学]