胸骨后甲状腺肿的诊断和外科治疗.docVIP

胸骨后甲状腺肿的诊断和外科治疗 　　作者：徐震壮,胡斌,吴小波 作者单位：无锡市人民医院 胸外科,江苏 无锡 214023 　　【摘要】目的：探讨胸骨后甲状腺肿的临床表现、诊断方法和手术治疗方法。方法：对我院2001年1月至2008年12月收治的36例胸骨后甲状腺肿患者的临床资料进行回顾分析。结果：36例均为Ⅰ型坠入性胸骨后甲状腺肿,且为部分型,并经病理学检查证实;其中结节性甲状腺肿25例,甲状腺腺瘤8例,甲状腺囊腺病3例。33例采用颈部低位领式切口,3例采用颈部低位领式切口+部分胸骨劈开;行甲状腺大部切除28例,双侧甲状腺次全切除8例。全组无手术及住院死亡病例。术后发生声嘶8例,其中5例术前有声嘶症状;一过性手足抽搐6例。结论：胸骨后甲状腺病变是颈部甲状腺的病变向下延续所致,且大部分患者手术可经颈部低位领式切口完成,必要时行胸骨部分劈开。 　　【关键词】 甲状腺肿; 胸骨后; 诊断; 外科治疗 　　Diagnosis and surgical treatment of substernal goiter 　　XU Zhenzhuang,HU Bin,WU Xiaobo 　　(Department of Thoracic Surgery,People′s Hospital of Wuxi City,Wuxi 214023,China) 　　[Abstract] Objective:To investigate the clinical manifestations,diagnostics and surgical treatment of substernal goiter.Methods：The clinical data of 36 patients with substernal goitre in our hospital from January 2001 to December 2008 were reviewed.Results:Thirtysix cases were all type Ⅰ fall into sexual retrosternal goiter, for parttype.Twentyfive cases were confirmed to be nodular goiter by pathology,8 cases were thyroid adenoma and 3 cases were thyroid cystic adenosis.Thirtythree cases underwent low neck and collartype incision,and 3 cases underwent low neck and collartype incision plus part of the sternotomy.Total thyroidectomy was taken in 28 cases and bilateral subtotal thyroidectomy was underwent in 8 cases.There were no died during the operation and hospitalization.There was postoperative hoarseness in 8 cases,including 5 cases of hoarseness before surgery.Six cases took place handfoot convulsions.Conclusion:Substernal thyroid disease is a downward continuation of the neck caused by thyroid disease,and the majority of patients after surgery may be low neck collar incision completed,if necessary,additional sternal part of the split. 　　[Key words] goiter; substernal; diagnosis; surgical treament 　　临床上异位甲状腺较为少见,位于胸骨后的甲状腺更是罕见,通常是颈部甲状腺向胸骨后突出而形成。胸骨后甲状腺病变是较为常见的上纵隔占位性病变。其临床特征和手术技巧与一般颈部甲状腺疾病有所不同。我院自2001年1月至2008年12月共收治胸骨后甲状腺肿患者36例,现分析如下。 　　1 临床资料 　　1.