颈部入路切除颈胸骨后巨大甲状腺肿的手术思考  

Surgical thinking about a cervical approach to remove a huge goiter behind the sternum

作　　者：王丽芬[1] 黄志纯[1] 杜银娟 WANG Lifen;HUANG Zhichun;DU Yinjuan(Department of Otolaryngology Head and Neck Surgery,Zhongda Hospital,Southeast University,Nanjing,Jiangsu,210009,China)

机构地区：[1]东南大学附属中大医院耳鼻咽喉头颈外科,江苏南京210009

出　　处：《中国耳鼻咽喉头颈外科》2024年第9期549-553,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨巨大胸骨甲状腺肿经颈部手术进路切除及手术方法。方法回顾性分析东南大学附属中大医院耳鼻咽喉头颈外科2016年1月~2022年12月期间收治的31例颈胸骨后巨大甲状腺肿患者的临床资料。结果所有患者均采用颈前低位领形切口完整切除肿瘤,平均手术时间131.64 min,平均出血量80 ml。手术方式:甲状腺全切除18例,甲状腺左叶及峡部切除9例,甲状腺右叶及峡部切除4例。术后转入重症监护室过渡者2例,余29例均返回普通病房,无死亡病例。术后病理类型:结节性甲状腺肿21例,甲状腺乳头状癌4例,甲状腺滤泡性肿瘤2例,甲状腺滤泡性癌2例,甲状腺大B细胞淋巴瘤1例,甲状腺交界性肿瘤1例。随访6个月~3年,无复发病例。结论经颈部入路行颈胸骨后巨大甲状腺肿的手术治疗,术前需充分评估并严格掌握手术指征,采用颈部低领切口,术中通过逐步结扎甲状腺主要供血血管,逐步分离,将巨大甲状腺肿从胸骨后牵拉出,在颈部成功完整切除,避免开胸手术,减少相关并发症的发生,并缩短患者病程。OBJECTIVE To explore the surgical approach and method for treating giant sternal goiter through the neck.METHODS A retrospective analysis was conducted on the clinical data of 31 patients with massive retrosternal goiter admitted to the Department of Otolaryngology Head and Neck Surgery at Southeast University Affiliated Zhongda Hospital from January 2016 to December 2022.RESULTS All patients underwent complete tumor resection through a low neck neck incision,with an average surgical time of 131.64 minutes and an average blood loss of 80 ml.Surgical methods:Total thyroidectomy in 18 cases,left lobe and isthmus resection in 9 cases,and right lobe and isthmus resection in 4 cases.Two cases were transferred to the intensive care unit for transition after surgery,and the remaining 29 cases were all returned to the general ward;No deaths have occurred;Postoperative pathology:The postoperative pathological types were nodular goiter in 21 cases,papillary thyroid carcinoma in 4 cases,follicular thyroid tumors in 2 cases,follicular thyroid carcinoma in 2 cases,large B-cell lymphoma in 1 case,and thyroid borderline tumor in 1 case.Follow up for 6 months to 3 years,with no recurrence cases.CONCLUSION The surgical treatment of huge thyroid nodules behind the sternum through the cervical approach requires thorough preoperative evaluation,understanding of surgical indications,and the use of a low neck incision.During the operation,the main blood vessels supplying the thyroid gland are gradually ligated,separated,and the huge thyroid nodules are pulled out from behind the sternum,successfully and completely removed from the neck,avoiding open chest surgery,reducing the occurrence of related complications,and shortening the patient's course of illness.

关 键 词：甲状腺肿 胸骨后 甲状腺切除术 外科手术 颈部切口 

分 类 号：R653[医药卫生—外科学]