30例胸骨后甲状腺肿的外科治疗  

Surgical treatment of substernal goiter：an analysis of 30 patients

作　　者：孙国荣[1] 张辉[1] 陈国涵[1] 王从俊[1] 

机构地区：[1]同济大学附属上海东方医院普外科,200120

出　　处：《临床外科杂志》2009年第6期398-399,共2页Journal of Clinical Surgery

摘　　要：目的探讨胸骨后甲状腺肿的诊断、治疗和术后并发症。方法回顾性分析我院1989年至2008年收治30例胸骨后甲状腺肿患者的诊断、治疗资料。结果30例患者中，多结节性甲状腺肿24例，滤泡性甲状腺瘤2例，复发性甲状腺肿3例，亚急性甲状腺炎1例。28例手术可以通过颈部低位领形切口手术完成，2例需要劈开胸骨。主要的临床症状包括呼吸困难18例，吞咽困难5例，多汗症2例；术后并发症包括4例暂时的喉返神经损伤，血肿2例，短暂的低钙血症2例，2例声音嘶哑。结论绝大多数胸骨后甲状腺肿患者完全可以选择用颈部低位领形切口手术，术中辨明并保护甲状旁腺和喉返神经对于减少术后并发症具有重要的意义。Objective To review the diagnosis,treatment, and postoperative complications of 30 patients with substernal goiter. Methods The clinical data of 30 patients with substernal goiters subject to thyroid resection were retrospectively analyzed from March 1989 to March 2008 in our hospital. Resuit The leading preoperative symptoms were dyspnea （60.0%）, dysphagia （16.67%）, and hyperhidrosis （6.67%）. All but two thyroid glands could be removed through a sternotomy. The most common postoperative complications were temporary paresis of the recurrent laryngeal nerve （ 13.33% ） , transient hypocalcemia （ 6.67 % ）, hematoma （ 6.67 % ）, and hoarse voice （ 6.67 % ）. Conclusion Transverse collar incision should be the standard approach for most patients. The visual identification of parathyroid glands and recurrent laryngeal nerve is essential to prevent postoperative complications.

关 键 词：胸骨后甲状腺肿 甲状腺切除 低位领形切口 喉返神经 并发症 

分 类 号：R653[医药卫生—外科学]