胸骨后甲状腺的手术：82例评估

文献信息

中文摘要

引言： 胸骨后甲状腺肿（RSG）仍是甲状腺手术中最具挑战性的情况之一，因为其纵隔延伸范围多变、与重要纵隔结构关系密切，且偶尔需要颈外手术入路。尽管围手术期管理的进步改善了手术结局，但当代长期单中心经验仍然有限。本研究旨在评估在一家三级转诊中心13年间治疗的胸骨后甲状腺肿患者的临床特征、手术管理、术后结局和组织病理学发现。
方法： 开展了一项回顾性队列研究，纳入2012年1月至2025年6月在埃尔吉耶斯大学医学院因胸骨后甲状腺肿接受手术的连续患者。回顾性审查人口学特征、就诊症状、甲状腺功能、手术方式、术后并发症和组织病理学发现。
结果： 共纳入82例患者。平均年龄为55.0±13.0岁，59.8%为女性。颈部肿胀是最常见的就诊症状，而近三分之一患者为偶然诊断。91%的患者术前甲状腺功能正常。甲状腺全切除术是主要手术方式。80例患者（97.6%）采用经颈入路即可完成；1例因深部前纵隔延伸并纤维粘连至头臂血管而需要部分胸骨切开，1例因后纵隔食管后延伸并累及隆突下而接受开胸术。暂时性低钙血症是最常见的术后并发症，而永久性低钙血症和永久性喉返神经麻痹分别发生于3.7%和1.2%的患者。未发生需要再次手术的术后血肿、气管软化或围手术期死亡。79.3%的患者为良性多结节性或结节性胶质性甲状腺肿，而滤泡性腺瘤和其他良性病变占10.9%，恶性病变占该队列的9.8%。
结论： 在经验丰富者手中，超过97%的胸骨后甲状腺肿可通过经颈入路成功切除。颈外手术保留用于深部后纵隔食管后延伸或主动脉弓以下的广泛纵隔受累。全面的术前CT规划和在高容量三级转诊中心的多学科诊疗可确保最低的并发症率。

英文摘要

INTRODUCTION: Retrosternal goiter (RSG) remains one of the most challenging conditions in thyroid surgery because of its variable mediastinal extension, close relationship with vital mediastinal structures, and occasional need for extracervical surgical approaches. Although advances in perioperative management have improved surgical outcomes, contemporary long-term single-center experiences remain limited. This study aimed to evaluate the clinical characteristics, surgical management, postoperative outcomes, and histopathological findings of patients with retrosternal goiter treated over a 13-year period at a tertiary referral center.
METHODS: A retrospective cohort study was performed including consecutive patients who underwent surgery for retrosternal goiter at Erciyes University Faculty of Medicine between January 2012 and June 2025. Demographic characteristics, presenting symptoms, thyroid function, operative procedures, postoperative complications, and histopathological findings were retrospectively reviewed.
RESULTS: A total of 82 patients were included. The mean age was 55.0 ± 13.0 years, and 59.8% were female. Cervical swelling was the most common presenting symptom, while nearly one-third of patients were diagnosed incidentally. 91% of patients were euthyroid preoperatively. Total thyroidectomy was the predominant surgical procedure. A transcervical approach was sufficient in 80 patients (97.6%); one patient required partial sternotomy for deep anterior mediastinal extension with fibrous adhesions to the brachiocephalic vessels, and one underwent thoracotomy for posterior retroesophageal extension with subcarinal involvement. Temporary hypocalcemia was the most frequent postoperative complication, whereas permanent hypocalcemia and permanent recurrent laryngeal nerve palsy occurred in 3.7% and 1.2% of patients, respectively. No postoperative hematoma requiring reoperation, tracheomalacia, or perioperative mortality occurred. Benign multinodular or nodular colloid goiter was identified in 79.3% of patients, whereas follicular adenomas and other benign lesions accounted for 10.9%, and malignant lesions comprised 9.8% of the cohort.
CONCLUSION: In experienced hands, over 97% of retrosternal goiters can be successfully resected via a transcervical approach. Extracervical procedures are reserved for deep posterior retroesophageal extension or extensive mediastinal involvement below the aortic arch. Comprehensive preoperative CT planning and multidisciplinary care in high-volume tertiary referral centers ensure minimal morbidity.