中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
Chinese Journal of General Surgery
2015年
9期
692-694
,共3页
李胜龙%张好刚%佟柏峰%王夫景%姜慧杰%杨维良
李勝龍%張好剛%佟柏峰%王伕景%薑慧傑%楊維良
리성룡%장호강%동백봉%왕부경%강혜걸%양유량
甲状腺肿,胸骨后%诊断%甲状腺切除术
甲狀腺腫,胸骨後%診斷%甲狀腺切除術
갑상선종,흉골후%진단%갑상선절제술
Goiter,substernal%Diagnosis%Thyroidectomy
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)颈低领式切口手术切除74例;(2)较大、更低的低领式切口,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.
目的 總結胸骨後甲狀腺腫外科手術治療經驗.方法 胸骨後甲狀腺腫102例均行手術切除,手術方式包括:(1)頸低領式切口手術切除74例;(2)較大、更低的低領式切口,肩部墊枕約高20度使頸部過伸,此法手術切除12例;(3)橫斷一側或雙側舌骨下肌群手術切除8例;(4)頸部低領式切口加胸部正中縱切口,胸骨體在2、3肋間橫嚮鋸斷,顯露上縱隔血管及病變,直視下完整切除甲狀腺癌或巨大甲狀腺腫8例.結果 所有患者手術均穫成功.術後聲嘶7例,4例1箇月後髮聲恢複正常,3例因癌侵犯喉返神經,聲嘶無改善.9例甲狀徬腺損傷緻低鈣抽搐,2~3箇月均恢複.本組102例均穫隨訪1~3年均無複髮. 結論 經頸部切口或胸骨部分劈開手術適于胸骨後甲狀腺腫手術.術前CT掃描、胸片對手術方式的選擇具有指導意義.
목적 총결흉골후갑상선종외과수술치료경험.방법 흉골후갑상선종102례균행수술절제,수술방식포괄:(1)경저령식절구수술절제74례;(2)교대、경저적저령식절구,견부점침약고20도사경부과신,차법수술절제12례;(3)횡단일측혹쌍측설골하기군수술절제8례;(4)경부저령식절구가흉부정중종절구,흉골체재2、3륵간횡향거단,현로상종격혈관급병변,직시하완정절제갑상선암혹거대갑상선종8례.결과 소유환자수술균획성공.술후성시7례,4례1개월후발성회복정상,3례인암침범후반신경,성시무개선.9례갑상방선손상치저개추휵,2~3개월균회복.본조102례균획수방1~3년균무복발. 결론 경경부절구혹흉골부분벽개수술괄우흉골후갑상선종수술.술전CT소묘、흉편대수술방식적선택구유지도의의.
Objective To summarize surgical experience for the treatment of substernal goiter.Methods 102 cases of substernal 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.