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首页> 外文期刊>Journal of Thoracic Disease >Resection of a giant bilateral retrovascular intrathoracic goiter causing severe upper airway obstruction, 2 years after subtotal thyroidectomy: a case report and review of the literature
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Resection of a giant bilateral retrovascular intrathoracic goiter causing severe upper airway obstruction, 2 years after subtotal thyroidectomy: a case report and review of the literature

机译：甲状腺全切除术2年后切除双侧巨大的胸腔后血管内甲状腺肿，导致严重的上呼吸道阻塞：一例病例并文献复习

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摘要

The intrathoracic (or substernal) goiter is more often benign; but it can be malignant in 2-22% of patients. There is history of prior thyroid surgery in 10% to more than 30% of patients. Intrathoracic goiters cause adjacent structure compression more frequently than the cervical goiters, due to the limited space of the thoracic cage. Compression of trachea, oesophagus, vascular and neural structures may cause dyspnoea, dysphagia, superior vena cava syndrome, subclavian vein thrombosis, hoarseness, and Horner’s syndrome. There is usually progressive deterioration, but acute exacerbation may occur. The presence of a thoracic goiter (>50% of the mass below the thoracic inlet) is per se an indication for resection. Tracheal compression by (cervical or thoracic) goiter is also an indication for resection; early tracheal decompression is recommended particularly in symptomatic patients. In severe respiratory distress, intubation and semi-urgent operation may be required. With early intervention, most intrathoracic goiters can be removed through a cervical approach, while tracheomalakia is avoided. We hereby present successful and uncomplicated total thyroidectomy, through a median sternotomy, of a benign, gigantic, bilateral, retrovascular, posterior mediastinal, intrathoracic goiter, encircling the trachea, and causing severe respiratory distress in a 63 year old man with history of previous subtotal thyroidectomy.
机译：胸腔内（或胸骨下）甲状腺肿通常是良性的。但在2-22％的患者中可能是恶性的。有10％至30％以上的患者曾接受甲状腺手术。由于胸腔的空间有限，胸腔内甲状腺肿比宫颈甲状腺肿更容易引起邻近结构受压。气管，食道，血管和神经结构受压可能导致呼吸困难，吞咽困难，上腔静脉综合征，锁骨下静脉血栓形成，声音嘶哑和霍纳氏综合症。通常会进行性恶化，但可能会急性加重。胸部甲状腺肿的存在（大于胸部入口质量的50％）本身就是切除的指征。甲状腺肿（颈或胸）气管压迫也可切除。建议对有症状的患者进行早期气管减压。在严重的呼吸窘迫中，可能需要插管和半紧急操作。通过早期干预，大多数胸腔内甲状腺肿可通过宫颈入路切除，同时避免了气管镜。我们在此通过中位胸骨切开术成功，简单地行良性，巨大，双侧，后血管，后纵隔，胸腔内甲状腺肿大，包围气管的正中胸骨切开术，并导致63岁以前有小计史的男性严重呼吸窘迫甲状腺切除术。

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