Management of thyroid goiters invading mediastinum and thoracic cavity
10.3760/cma.j.issn.1673-0860.2011.08.009
- VernacularTitle:累及纵隔和胸腔的甲状腺肿物诊疗分析
- Author:
Jie CHEN
1
;
Jian-Jun YU
;
Wei WEI
;
Zan LI
;
Wen-Xiao HUANG
;
Rong-Hua BAO
;
Li XIE
;
Jin-Yun LI
;
Hai-Lin ZHANG
Author Information
1. 湖南省肿瘤医院
- Keywords:
Goiter,nodular;
Thyroid neoplasms;
Thoracic cavity;
Mediastinum
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2011;46(8):654-657
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the diagnosis and treatments of thyroid goiters invading mediastinum and thoracic cavity. Methods Seventy-eight cases of thyroid goiters invading mediastinum and thoracic cavity and undergoing surgery from 1995 to 2005 were reviewed. There were 22 males and 56 females and their age ranged from 45 years to 78 years with a median age of 59 years. According to the classification of intrathoracic thyroid goiters, there were 50 cases in Class Ⅰ , 20 cases in Class Ⅱ and 8 cases in Class Ⅲ. In these patients,38 cases suffered from dyspnea at degree [ and 20 cases at degree Ⅱ.Of the patients, 71 underwent thyroidectomy through neck approach and 7 underwent thyroidectomy by a combined approach of neck incision plus stemotomy or lateral thoracotomy. Tracheal defects in 4 cases and esophageal defects in 3 cases were repaired. Postoperative residual diseases were found in tracheoesophageal wall(5 cases) and mediastinum (6 cases). Eleven patients received postoperative radiotherapy and 18 underwent 131 Ⅰ treatment. No case died of operation and no case with wound infection. Results The time of follow-up was 60 - 180 months with a median of 110 months. Three patients lost follow-up. Dyspnea in 58 cases were improved after operation. Three of 49 patients with nodular goiters died from cardiocerebrovascular diseases. Of 29 patients with thyroid papillary carcinoma, 2 died from lung metastasis and 3 died from neck relapse. Five-year survival rate was 75.0% in the patients with thyroid cancer.Conclusions Most of thyroid goiters invading mediastinum and thoracic cavity can be completely resected via neck approach, but a combined approach of neck incision plus stemotomy or lateral thoracotomy may be used in some cases with malignant goiters to dissect the diseases completely. Postoperative external beam radiotherapy are required for the residual diseases. 131Ⅰ may be considered in high-risk differentiated thyroid carcinoma cases.
