多学科诊疗模式下巨大甲状腺肿切除术  

Surgical Treatment of Giant Goiter With Multi-disciplinary Teams

作　　者：周京安[1] 骆成玉 张晶[2] 李洋[1] Zhou Jing’an;Luo Chengyu;Zhang Jing(Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100029 [2]首都医科大学附属北京安贞医院麻醉科,北京100029

出　　处：《中国微创外科杂志》2022年第6期472-476,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结多学科诊疗模式下巨大甲状腺肿手术的体会。方法回顾性分析2018年6月~2022年1月同组医师对37例巨大甲状腺肿行手术治疗的临床资料,术前影像科协助评价邻近器官受压情况,麻醉科评估气管狭窄插拔管难度,耳鼻喉科协助判断气管软化及术后气管切开风险,外科重症监护室(Surgical Intensive Care Unit,SICU)、内分泌科、心内科、呼吸科有针对性进行围手术期管理,个体化选择麻醉方式,外科精细操作,行甲状腺腺叶全切或近全切除手术,术后观察有无呼吸困难、声音嘶哑、低钙血症、出血等并发症发生。结果手术顺利完成,单侧甲状腺叶近全或全切除26例,双侧甲状腺叶近全或全切除11例,其中气管悬吊9例。手术时间50~125 min,(82.7±22.2)min;术中出血量20~150 ml,(63.8±29.8)ml。术后暂时性甲状旁腺功能减退和暂时性声音嘶哑各1例。门诊随访2~43个月,平均18个月,未见腺肿复发。结论巨大甲状腺肿手术需要多学科协作,充分术前评估准备,精细操作,严格围手术期管理,避免窒息的发生。Objective To summarize the experience of surgical resection of giant goiter with multi-disciplinary teams.Methods Clinical data of 37 patients with giant goiters who underwent surgical resection from June 2018 to January 2022 in our hospital were retrospectively analyzed.All the procedures were completed by the same group of surgeons.Preoperatively,the Department of Imaging participated in estimating the compression of adjacent organs,the Department of Anesthesiology evaluated the difficulty of intubation and extubation caused by tracheal stenosis,the Department of Otorhinolaryngology helped judge the risk of tracheomalacia and possibility of postoperative tracheotomy,and the Surgical Intensive Care Unit(SICU)and Departments of Endocrinology,Cardiology and Respiratory Diseases carried out targeted perioperative management.Individualized selection of anesthesia methods and fine surgical operation were needed.Total or subtotal thyroidectomy was performed.Postoperatively,it was observed whether there occurred such complications as dyspnea,hoarseness,hypocalcemia and bleeding.Results All the procedures were accomplished successfully,including 26 cases of unilateral total or subtotal thyroidectomy and 11 cases of bilateral total or subtotal thyroidectomy.Tracheal suspension was performed in 9 cases.The operative time was 50-125 min(mean,82.7±22.2 min);the intraoperative blood loss was 20-150 ml(mean,63.8±29.8 ml).There were 1 case of temporary hypoparathyroidism and 1 case of transient hoarseness during early stage.All the patients were followed up for 2-43 months(mean,18 months)in clinic.No goiter recurrence was observed.Conclusions The implementation of giant goiter resection requires joint efforts of multi-disciplinary teams.Adequate preoperative assessment and preparation,fine anatomy and strict perioperative management can effectively avoid the occurrence of asphyxia.

关 键 词：巨大甲状腺肿 甲状腺切除术 多学科诊疗模式 围手术期 并发症 

分 类 号：R47[医药卫生—护理学]