良性巨大甲状腺肿的手术技巧(附15例报告)  

Techniques of thyroidectomy for massive goiter:15 cases report

作　　者：檀谊洪[1] 杜国能[1] 严国标[1] 陈庞州[1] 谭东兴[1] 王昆[1] 肖玉根[1] 

机构地区：[1]南方医科大学附属南海医院甲乳外科,广东佛山528200

出　　处：《临床耳鼻咽喉头颈外科杂志》2013年第6期296-299,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨良性巨大甲状腺肿的手术技巧。方法:15例患者26侧良性巨大甲状腺肿,全身麻醉下采用被膜解剖技术行甲状腺次全切除术。结果:术中先处理下极和上极者分别为19侧和7侧;术中见甲状旁腺4、3、2枚者分别为7、2、6例;行气管悬吊术2例;术中残留双侧腺体8～10g;手术时间110～170min,术中失血量50～250ml;术后引流量70～170ml;无术后气管塌陷及再出血病例;术后暂时性甲状旁腺机能减退2例;无喉上及喉返神经损伤病例;误切1枚甲状旁腺者2例。结论:妥善解决暴露、止血、困难上极和下极的处理、喉返神经和甲状旁腺保护、预防气管塌陷的问题,巨大良性甲状腺肿的手术是安全的。Objective：To investigate the techniques of thyroidectomy for massive goiter. Method..We retrospec- tively reviewed the records of 15 patients who underwent thyroidectomy by technique of capsular dissection for massive goiter. Result：Thyroidectomy was successfully performed in all the patients. In operation, the priority dis- section of superior and inferior pole was 19 and 7 cases, respectively. The 4, 3, 2 parathyroid glands could be i- dentified in 7, 2, 6 patients, respectively. Tracheal suspension was performed in 2 patients. 8--10 g residual glands were remained in all patients. Operating time was 110--170 min, blood loss was 50--250 ml, postoperative drainage was 70--170 ml. Trachea collapse, postoperative hemorrhage, superior laryngeal nerve and recurrent la- ryngeal nerve palsy were not observed, and transient hypocaleemia occurred in 2 patients. Inadvertent parathyroid excision was found in 2 patients. Pathological examination shows 13 eases of nodular goiter and two cases of hy- perthyroidism. Conclusion：Given properly resolve the problem of exposure, bleeding, difficult dissection of superi- or and inferior pole, protection of recurrent laryngeal nerve and parathyroid, thyroidectomy is safe for massive goi- ter.

关 键 词：巨大甲状腺肿 甲状腺切除术 被膜解剖技术 超声刀 

分 类 号：R615[医药卫生—外科学]