Operation Skill for Removal of Benign Substernal Goiters Through Cervical Approach_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Lei , SANG Jianfeng , YAO Yongzhong , WANG Xuechen

Department of General Surgery， Affiliated Drum Tower Hospital of Nanjing University Medical School， Nanjing 210008， Jiangsu Province， China;

Corresponding author：

Keywords：

Substernal; Goiter; Cervical approach; Surgery

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Objective 　To explore the feasibility and safety of removal of benign substernal goiter through cervical approach and summarize the operation skill.
Methods 　The clinical data of 85 cases diagnosed as benign substernal goiter from August 2002 to October 2011 in this hospital were analyzed retrospectively.
Results 　The removal of benign substernal goiters in all 85 cases were performed through cervical approach without perioperative death，respiratory tract obstruction，massive haemorrhage，pneumothorax，hemothorax，chylus leakage，permanent impairment of recurrent laryngeal nerve，and permanent hypoparathyroidism. Three cases of hoarseness were found on 1-3d after operation，which returned to normal after symptomatic treatment. Four cases of numbness in the extremities and one case of mild convulsion happened，the symptoms were relieved through intravenous and oral administration of calcium treatment in 3-7d. The drainage volume was 35-220ml with （68±4.9） ml. The drainage tube was removed on postoperative 2-6d with an average 4.2d. Eighty-two patients were followed-up in 2 years after operation，no low calcium，low parathyroid hormone，hoarseness，and local goiter recurrence occurred. Two cases of hypothyroidism returned to normal after oral thyroxine dose adjustment.
Conclusions 　Removal of the downward benign substernal goiter through cervical approach is safe and feasible. Sufficient exposure，stepwise procedure，blunt dissection in the precise gap，and combination of lifting with upbearing are the surgical skills for success.

Citation： SU Lei,SANG Jianfeng,YAO Yongzhong,WANG Xuechen,.. Operation Skill for Removal of Benign Substernal Goiters Through Cervical Approach. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(8): 868-870. doi: Copy

1.	武正炎，沈美萍. 结节性甲状腺肿诊治进展[J]. 中国普外基础与临床杂志， 2004， 11(6)：483-485.
2.	张志庸，崔玉尚，周易东，等. 胸骨后甲状腺肿的诊断和治疗[J]. 中华外科杂志， 2001， 39(4)：291-293.
3.	Hegedüs L， Bonnema SJ. Approach to management of the patient with primary or secondary intrathoracic goiter[J]. J Clin Endocrinol Metab， 2010， 95(12)：5155-5162.
4.	Page C， Strunski V. Cervicothoracic goitre：an anatomical or radiological definition? Report of 223 surgical cases[J]. J Laryngol Otol， 2007， 121(11)：1083-1087.
5.	马步云， Sundar PS，彭玉兰，等. 甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用[J]. 中国普外基础与临床杂志， 2011， 18(8)：898-901.
6.	Mercante G， Gabrielli E， Pedroni C， et al. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach[J]. Head Neck， 2011， 33(6)：792-799.
7.	余生林，贾磊. 胸骨后甲状腺肿的外科治疗[J]. 宁夏医学杂志， 2010， 32(6)：545-546.
8.	Singh B， Lucente FE， Shaha AR. Substernal goiter：a clinical review[J]. Am J Otolaryngol， 1994， 15(6)：409-416.
9.	巢琳，郑南翔，陈力平. 23例胸骨后甲状腺肿的外科治疗[J]. 南京医科大学学报(自然科学版)， 2009， 29(10)：1454-1455.
10.	吴跃煌，祁永发，唐平章，等. 胸骨后甲状腺肿的手术径路[J]. 中华耳鼻咽喉头颈外科杂志， 2006， 41(7)：528-531.
11.	Calò PG， Tatti A， Farris S， et al. Substernal goiter：personal experience[J]. Ann Ital Chir， 2005， 76(4)：331-335.
12.	石岚，程波，刘春萍，等. 胸骨后甲状腺疾病的诊断和外科治疗[J]. 中华普通外科杂志， 2006， 21(9)：644-646.
13.	Paliogiannis P， Scoqnamillo F， Denti S， et al. Surgical treatment of a patient with retrosternal thyroid goiter[J]. Ann Ital Chir， 2009， 80(6)：429-433.
14.	程剑峰，陈伟. 胸骨后甲状腺肿外科手术治疗体会[J]. 岭南现代临床外科杂志， 2011， 11(3)：204-205.
15.	王志军. 胸骨后结节性甲状腺肿的诊治体会[J]. 医药论坛杂志， 2010， 31(20)：132-133.
16.	Rugiu MG， Piemonte M. Surgical approach to retrosternal goitre：do we still need sternotomy?[J]. Acta Otorhinolaryngol Ital， 2009， 29(6)：331-338.
17.	Neves MC， Rosano M， Hojaij FC， et al. A critical analysis of 33 patients with substernal goiter surgically treated by neck incision[J]. Braz J Otorhinolaryngol， 2009， 75(2)：172-176.
18.	Bizakis J， Karatzanis A， Hajiioannou J， et al. Diagnosis and management of substernal goiter at the University of Crete[J]. Surg Today， 2008， 38(2)：99-103.
19.	魏涛，朱精强. 甲状腺手术理念进展与新型手术器械在甲状腺外科中的应用[J]. 中国普外基础与临床杂志， 2011， 18(2)：220-224.
20.	Shin JJ， Grillo HC， Mathisen D， et al. The surgical management of goiter：Part I. Preoperative evaluation[J]. Laryngoscope， 2011， 121(1)：60-67.
21.	Rios A， Rodriquez JM， Balsalobre MD， et al. The value of various definitions of intrathoracic goiter for predicting intraoperative and postoperative complications[J]. Surgery， 2010， 147(2)：233-238.
22.	Testini M， Piccinni G， Lissidini G， et al. The lifting of substernal goitres using a Fogarty catheter[J]. Ann R Coll Surg Engl， 2005， 87(1)：63-64.
23.	吕勇刚，袁时芳，姚青，等. 巨大甲状腺肿合并胸骨后病变或气管软化的外科处理[J]. 现代肿瘤医学， 2011， 19(3)：452-453.
24.	Raffaelli M， De Crea C， Ronti S， et al. Substernal goiters：incidence， surgical approach， and complications in a tertiary care referral center[J]. Head Neck， 2011， 33(10)：1420-1425.
25.	Al-Mufarrej F， Margolis M， Tempesta B， et al. Novel thoracoscopic approach to posterior mediastinal goiters：report of two cases[J]. J Cardiothorac Surg， 2008， 3：55.

1. 武正炎，沈美萍. 结节性甲状腺肿诊治进展[J]. 中国普外基础与临床杂志， 2004， 11(6)：483-485.
2. 张志庸，崔玉尚，周易东，等. 胸骨后甲状腺肿的诊断和治疗[J]. 中华外科杂志， 2001， 39(4)：291-293.
3. Hegedüs L， Bonnema SJ. Approach to management of the patient with primary or secondary intrathoracic goiter[J]. J Clin Endocrinol Metab， 2010， 95(12)：5155-5162.
4. Page C， Strunski V. Cervicothoracic goitre：an anatomical or radiological definition? Report of 223 surgical cases[J]. J Laryngol Otol， 2007， 121(11)：1083-1087.
5. 马步云， Sundar PS，彭玉兰，等. 甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用[J]. 中国普外基础与临床杂志， 2011， 18(8)：898-901.
6. Mercante G， Gabrielli E， Pedroni C， et al. CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach[J]. Head Neck， 2011， 33(6)：792-799.
7. 余生林，贾磊. 胸骨后甲状腺肿的外科治疗[J]. 宁夏医学杂志， 2010， 32(6)：545-546.
8. Singh B， Lucente FE， Shaha AR. Substernal goiter：a clinical review[J]. Am J Otolaryngol， 1994， 15(6)：409-416.
9. 巢琳，郑南翔，陈力平. 23例胸骨后甲状腺肿的外科治疗[J]. 南京医科大学学报(自然科学版)， 2009， 29(10)：1454-1455.
10. 吴跃煌，祁永发，唐平章，等. 胸骨后甲状腺肿的手术径路[J]. 中华耳鼻咽喉头颈外科杂志， 2006， 41(7)：528-531.
11. Calò PG， Tatti A， Farris S， et al. Substernal goiter：personal experience[J]. Ann Ital Chir， 2005， 76(4)：331-335.
12. 石岚，程波，刘春萍，等. 胸骨后甲状腺疾病的诊断和外科治疗[J]. 中华普通外科杂志， 2006， 21(9)：644-646.
13. Paliogiannis P， Scoqnamillo F， Denti S， et al. Surgical treatment of a patient with retrosternal thyroid goiter[J]. Ann Ital Chir， 2009， 80(6)：429-433.
14. 程剑峰，陈伟. 胸骨后甲状腺肿外科手术治疗体会[J]. 岭南现代临床外科杂志， 2011， 11(3)：204-205.
15. 王志军. 胸骨后结节性甲状腺肿的诊治体会[J]. 医药论坛杂志， 2010， 31(20)：132-133.
16. Rugiu MG， Piemonte M. Surgical approach to retrosternal goitre：do we still need sternotomy?[J]. Acta Otorhinolaryngol Ital， 2009， 29(6)：331-338.
17. Neves MC， Rosano M， Hojaij FC， et al. A critical analysis of 33 patients with substernal goiter surgically treated by neck incision[J]. Braz J Otorhinolaryngol， 2009， 75(2)：172-176.
18. Bizakis J， Karatzanis A， Hajiioannou J， et al. Diagnosis and management of substernal goiter at the University of Crete[J]. Surg Today， 2008， 38(2)：99-103.
19. 魏涛，朱精强. 甲状腺手术理念进展与新型手术器械在甲状腺外科中的应用[J]. 中国普外基础与临床杂志， 2011， 18(2)：220-224.
20. Shin JJ， Grillo HC， Mathisen D， et al. The surgical management of goiter：Part I. Preoperative evaluation[J]. Laryngoscope， 2011， 121(1)：60-67.
21. Rios A， Rodriquez JM， Balsalobre MD， et al. The value of various definitions of intrathoracic goiter for predicting intraoperative and postoperative complications[J]. Surgery， 2010， 147(2)：233-238.
22. Testini M， Piccinni G， Lissidini G， et al. The lifting of substernal goitres using a Fogarty catheter[J]. Ann R Coll Surg Engl， 2005， 87(1)：63-64.
23. 吕勇刚，袁时芳，姚青，等. 巨大甲状腺肿合并胸骨后病变或气管软化的外科处理[J]. 现代肿瘤医学， 2011， 19(3)：452-453.
24. Raffaelli M， De Crea C， Ronti S， et al. Substernal goiters：incidence， surgical approach， and complications in a tertiary care referral center[J]. Head Neck， 2011， 33(10)：1420-1425.
25. Al-Mufarrej F， Margolis M， Tempesta B， et al. Novel thoracoscopic approach to posterior mediastinal goiters：report of two cases[J]. J Cardiothorac Surg， 2008， 3：55.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Operation Skill for Removal of Benign Substernal Goiters Through Cervical Approach

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