摘要
目的总结胸骨后甲状腺肿外科手术治疗经验。方法胸骨后甲状腺肿102例均行手术切除，手术方式包括：（1）颈低领式切1：3手术切除74例；（2）较大、更低的低领式切1：3，肩部垫枕约高20度使颈部过伸，此法手术切除12例；（3）横断一侧或双侧舌骨下肌群手术切除8例；（4）颈部低领式切口加胸部正中纵切口，胸骨体在2、3肋间横向锯断，显露上纵隔血管及病变，直视下完整切除甲状腺癌或巨大甲状腺肿8例。结果所有患者手术均获成功。术后声嘶7例，4例1个月后发声恢复正常，3例因癌侵犯喉返神经，声嘶无改善。9例甲状旁腺损伤致低钙抽搐，2～3个月均恢复。本组102例均获随访1-3年均无复发。结论经颈部切口或胸骨部分劈开手术适于胸骨后甲状腺肿手术。术前CT扫描、胸片对手术方式的选择具有指导意义。
Objective To summarize surgical experience for the treatment of substernal goiter. Methods 102 cases of substemal goiter underwent surgical resection, in 74 by low collar incision, 12 cases by larger low collar incision and pillowing the shoulder pad about 20 degrees for neck hyperextension, 8 cases by unilateral or bilateral infrahyoid muscles transection, 8 cases by low collar and up-mid-sternal incision plus horizontal sawing in 2 and 3 ribs. Results Resection was performed successfully in all cases. Hoarseness occurred in 7 cases, 4 cases recovered after one month, 3 cases did not improve because of tumor invasion of laryngeal recurrent nerve. Postoperative transient hypocalcemia in 9 cases recovered after 2 to 3 months. 102 patients were followed up for 1 to 3 years without recurrence. Conclusions Substernal goiter can be resected successfully through a transcervical approach or mid-sternal incision. CT scanning and chest X radiograph are decisive for the surgical approach.
出处
《中华普通外科杂志》
CSCD
北大核心
2015年第9期692-694,共3页
Chinese Journal of General Surgery
