27例巨大甲状腺肿块患者手术经验分析  

Experience analysis of 27 cases of giant thyroid surgery

作　　者：张棕帆 王一帆 刘晓亚 陈征 吕晶 师丙帅[2] ZHANG Zongfan;WANG Yifan;LIU Xiaoya;CHEN Zheng;LYU Jing;SHI Bingshuai(Department of Thyroid Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450007,China;Department of Thyroid Surgery,First Affiliated Hospital of Henan University,Kaifeng,Henan 475001,China)

机构地区：[1]郑州大学附属郑州中心医院甲状腺外科,河南郑州450007 [2]河南大学第一附属医院甲状腺外科,河南开封475001

出　　处：《中华肿瘤防治杂志》2024年第3期147-151,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：河南省医学科技攻关计划联合共建项目(2018020789)。

摘　　要：目的探讨巨大甲状腺外科手术技巧及其并发症的防治。方法回顾性分析2015-01-01-2022-12-31河南大学第一附属医院收治的27例巨大甲状腺患者临床资料,其中颈领切口原位剥离法10例,颈领切口牵引提拉法11例,颈领切口联合胸腔镜2例,颈胸联合“T”型切口4例。结果所有患者甲状腺全切5例,单侧叶切除18例,单侧切除+对侧近全切4例。术后病理:结节性甲状腺肿14例,桥本氏甲状腺炎结节7例,腺瘤型结节4例,腺瘤合并乳头状癌2例。所有患者手术时间120~240 min,中位手术时间180 min;术中出血量20~340 mL,中位出血量50 mL。术后出现暂时性声嘶4例,饮水呛咳3例,术中甲状旁腺自体移植3例,暂时性甲状旁腺功能减退5例,给予补钙后均恢复正常。所有引流装置3~13 d后拔除,每日引流量10~100 mL。8例患者因术前呼吸困难或创伤较大转入重症监护室过渡,所有患者术后气管插管拔管均顺利,无气管塌陷及甲亢危象患者。27例患者均治愈出院,随访至2022-12-31无异常。结论采用不同手术入路,重视精细操作,注意神经、血管、旁腺、气管及食管的保护,可提高巨大甲状腺手术安全性,降低手术难度。Objective To explore the surgical technique of giant thyroid and the prevention and treatment of its complications. Methods Retrospective analysis was conducted on clinical data of 27 patients with giant thyroid admitted to the First Affiliated Hospital of Henan University from January 1, 2015 to December 31, 2022. All cases were divided into 4 kinds of operation methods: 10 cases were treated with cervical incision in situ dissection;11 cases were treated with cervical incision traction and lifting method;2 cases were treated with cervical collar incision combined with thoracoscopy;4 cases were treated with cervical thoracic combined with "T" incision. Results Total thyroidectomy was performed in 5 cases, unilateral lobectomy in 18 cases, and unilateral resection combined with contralateral subtotal resection in 4 cases. Postoperative pathology: nodular goiter in 14 cases, Hashimoto's thyroiditis in 7 cases, adenomatous nodules in 4 cases, adenoma with papillary carcinoma in 2 cases. The operative time of all patients was 120-240 min, and the median operative time was 180 min. Intraoperative blood loss was 20-340 ml, with a median of 50 mL. There were 4 cases of temporary hoarseness, 3 cases of cough due to drinking water, 3 cases of parathyroid autotransplantation and 5 cases of temporary hypoparathyroidism after operation, and all recovered to normal after calcium supplementation. All drainage devices were removed 3 to 13 days later, and the daily drainage flow was 10 to 100 ml. Eight patients were transferred to the intensive care unit due to preoperative dyspnea or severe trauma. All patients underwent tracheal intubation and extubation smoothly after operation. There were no cases of tracheal collapse and hyperthyroidism crisis. Twenty-seven cases were cured and discharged. No abnormality was found until December 31,2022. Conclusions It can improve the safety and reduce the difficulty of giant thyroid operation to adopt different surgical approaches. Operators should pay attention to fine operation and prot

关 键 词：巨大甲状腺 胸腔镜 颈胸联合 手术经验 

分 类 号：R736.1[医药卫生—肿瘤]