胸骨后甲状腺诊断治疗.docVIP

胸骨后甲状腺诊断治疗 　　【摘要】目的探讨胸骨后甲状腺疾病的临床表现、诊断和手术治疗。方法回顾性分析1995年1月至2008年1月手术治疗29例胸骨后甲状腺肿的临床资料。结果临床表现主要为无症状颈部肿物23例,颈部肿物伴随憋气3例,吞咽阻挡感3例。26例为坠入性胸骨后甲状腺肿,3例为胸内甲状腺肿。良性病变28例,伴随恶性病变1例。26例采用颈前部低领式切口,2例采用颈胸联合切口,1例颈部-肋间切口。结论多数胸骨后甲状腺肿是颈前部病变向下的延续,颈胸部CT检查是最有效的检查手段。多数患者手术可以经颈部低领式切口完成,必要时行颈胸联合切口。? 　　【关键词】 　　甲状腺肿;胸骨后;诊断;甲状腺部分切除术 　　?? 　　Diagnosis and Surgical Treatment of Substernal Goiter 　　? 　　【Abstract】ObjectiveTo investigate the clinical characteristicsdiagnosis and surgical treatment of substemal goiter.MethodsClinical data of 29 cases of substernal goiter from Jan 1995 to Jan 2008 were retrospectively analyzed.ResultsThe main symptoms of substernal goiter were asymptomatic cervical mass in 20 patients,airway obstruction in 3 ones,baffle when swallow in 3 ones respectively.There were 26 cases of descending 　　?? 　　substernal goiter and 3 cases of truly intrathoracic thyroid.Pathology identified benignity in 28 cases and m alignancy in 1.Operation were performed in 26 cases through low cervical incision ,in 2 ones with combined cervici-stenotomic approach,1 through cervical inter-ribs incision.ConclusionSubstemal goiters often result from the descent of a cervical goiter,CT scanning of neck and thorax is valuable in the diagnosis of substemal goiters.Most substernal goiters can be removed through a transcervical approach,although combined cervici-stemotomic approach is occasionally required ? 　　【Key words】 　　Goiter; Substernal; Diagnosis;Thyroidectomy. 　　? 　　胸骨后甲状腺肿在临床上比较常见,因为存在压迫以及部分可能存在恶性变,手术是最常见的治疗选择。1995年1月至2008年1月我院共手术治疗29例胸骨后甲状腺肿,现将体会报告如下。? 　　 　　1临床资料? 　　 　　1.1一般资料本组29例胸骨后甲状腺,占同期甲状腺手术的1.9%,其中男7例,女22例。年龄24~68岁,平均(40±11)岁。病史7 d~15年。既往有甲状腺手术史3例。26例为坠入性胸骨后甲状腺肿,3例为胸内异位甲状腺肿。单侧27例,双侧2例。恶性病变1例。临床表现主要为无症状颈部肿物23例,颈部肿物伴随憋气3例,吞咽阻挡感3例。体检:26例坠入性胸骨后甲状腺肿除3例患者不能扪及肿大的甲状腺外,余甲状腺均肿大,由于肿大的甲状腺大部分位于胸骨切迹下方,体检时Ⅰ度17例,Ⅱ度6例;气管移位24例,受压变形11例,颈、胸部X线片显示上纵隔增宽或肿物阴影21例。全部患者术前CT检查均证实为胸骨后甲状腺肿。典型病例见附图。? 　　 　　2治疗及结果? 　　 　　2.1治疗方法所有患者均接受气管插管全麻下手术。26例采用颈部低领式切口,2例采用颈胸联合切口,1例采用颈部-肋间cervical inter-ribs联合切口。