Treatment of cervico-mediastinal goiters

• 作者: Elisa Francone Emilio Falco Luigi D’Ambra Mario Cappagli Pierfrancesco Bonfante Prospero Magistrelli Rossella Leoncini
• 来源期刊: 世界外科手术杂志
• 学科: 医学
• 关键词: GOITER STERNOTOMY THYROIDECTOMY MEDIASTINUM THORACOTOMY
• 年，卷（期）: sjwksszz_2013,（3）
• 页码范围: 37-40
• 页数: 4页
• 分类号: R

摘要

AIM:To compare our ten year results for thyroidectomy for cervico-mediastinal goiters with the best surgical treatment reported in the literature.METHODS:From January 2000 to December 2009,of 1530 patients who underwent thyroidectomy in our department,we selected 105 cases of cervico-mediastinal goiter.In the majority of cases,the cervical approach is the standard procedure and only occasionally sternotomy or thoracotomy is necessary.The indications for surgery are generally related to a progressive increase of the thyroid mass into the anterior mediastinum with compression and dislocation of the trachea or esophagus and the possibility of an unknown malignancy.RESULTS:In 98(93.3%)of our 105 patients,the standard surgical approach was anterior cervicotomy followed by total thyroidectomy.In three cases,total sternotomy was performed and in the remaining four patients,a partial split sternotomy was effective to remove the intrathoracic mass.Post-operative complications included transient recurrent laryngeal nerve palsy in 6 patients(5.7%)which only became permanent in 2 patients(1.9%).The transient hypoparathyroidism rate was 22%but 2 mo after surgery permanent hypoparathyroidism was confirmed in only 2%of our selected group.No patients required temporary tracheostomy following surgery related to a possible bilateral nerve palsy.Patients received a single prophylactic antibiotic dose preoperatively and wound infections were not significant.There was no mortality in our selected group and most patients showed a significant improvement of dyspnea and other correlated symptoms postoperatively.CONCLUSION:The majority of cervico mediastinal goiters can be completely removed through a cervical incision.In selected cases,generally malignancies with local infiltration of mediastinal soft tissues and adhesions to large vessels,split sternotomy may be a safer approach to not increase morbidity.