[1]周京安 骆成玉* 张晶① 李洋.多学科诊疗模式下巨大甲状腺肿切除术[J].中国微创外科杂志,2022,01(6):472-476.
　Zhou Jingan*,Luo Chengyu*,Zhang Jing,et al.Surgical Treatment of Giant Goiter With Multidisciplinary Teams[J].Chinese Journal of Minimally Invasive Surgery,2022,01(6):472-476.
点击复制

多学科诊疗模式下巨大甲状腺肿切除术()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年6期
页码:
472-476
栏目:
临床研究
出版日期:
2022-10-11

文章信息/Info

Title:
Surgical Treatment of Giant Goiter With Multidisciplinary Teams
作者:
周京安 骆成玉* 张晶① 李洋
(首都医科大学附属北京安贞医院普外科，北京100029)
Author(s):
Zhou Jing’an*;  Luo Chengyu*;  Zhang Jing;  et al.
*Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
关键词:
巨大甲状腺肿; 甲状腺切除术; 多学科诊疗模式; 围手术期; 并发症
Keywords:
Giant goiter; Thyroidectomy; Multidisciplinary teams; Perioperative period; Complication
文献标志码:
A
摘要:
目的总结多学科诊疗模式下巨大甲状腺肿手术的体会。方法回顾性分析2018年6月~2022年1月同组医师对37例巨大甲状腺肿行手术治疗的临床资料，术前影像科协助评价邻近器官受压情况，麻醉科评估气管狭窄插拔管难度，耳鼻喉科协助判断气管软化及术后气管切开风险，外科重症监护室(Surgical Intensive Care Unit，SICU)、内分泌科、心内科、呼吸科有针对性进行围手术期管理，个体化选择麻醉方式，外科精细操作，行甲状腺腺叶全切或近全切除手术，术后观察有无呼吸困难、声音嘶哑、低钙血症、出血等并发症发生。结果手术顺利完成，单侧甲状腺叶近全或全切除26例，双侧甲状腺叶近全或全切除11例，其中气管悬吊9例。手术时间50~125 min，(82.7±22.2)min；术中出血量20~150 ml，(63.8±29.8)ml。术后暂时性甲状旁腺功能减退和暂时性声音嘶哑各1例。门诊随访2~43个月，平均18个月，未见腺肿复发。结论巨大甲状腺肿手术需要多学科协作，充分术前评估准备，精细操作，严格围手术期管理，避免窒息的发生。
Abstract:
ObjectiveTo summarize the experience of surgical resection of giant goiter with multidisciplinary teams.MethodsClinical data of 37 patients with giant goiters who underwent surgical resection from June 2018 to January 2022 in our hospital were retrospectively analyzed. All the procedures were completed by the same group of surgeons. Preoperatively, the Department of Imaging participated in estimating the compression of adjacent organs, the Department of Anesthesiology evaluated the difficulty of intubation and extubation caused by tracheal stenosis, the Department of Otorhinolaryngology helped judge the risk of tracheomalacia and possibility of postoperative tracheotomy, and the Surgical Intensive Care Unit (SICU) and Departments of Endocrinology, Cardiology and Respiratory Diseases carried out targeted perioperative management. Individualized selection of anesthesia methods and fine surgical operation were needed. Total or subtotal thyroidectomy was performed. Postoperatively, it was observed whether there occurred such complications as dyspnea, hoarseness, hypocalcemia and bleeding.ResultsAll the procedures were accomplished successfully, including 26 cases of unilateral total or subtotal thyroidectomy and 11 cases of bilateral total or subtotal thyroidectomy. Tracheal suspension was performed in 9 cases. The operative time was 50-125 min (mean, 82.7±22.2 min); the intraoperative blood loss was 20-150 ml (mean, 63.8±29.8 ml). There were 1 case of temporary hypoparathyroidism and 1 case of transient hoarseness during early stage. All the patients were followed up for 2-43 months (mean, 18 months) in clinic. No goiter recurrence was observed.ConclusionsThe implementation of giant goiter resection requires joint efforts of multidisciplinary teams. Adequate preoperative assessment and preparation, fine anatomy and strict perioperative management can effectively avoid the occurrence of asphyxia.

参考文献/References:

[1]张生来,刘颖,储冰峰,等.巨大甲状腺肿手术处理的策略和要点.外科理论与实践,2016,21(4):297-299.
[2]卢秀波,张明辉,刘征,等.良性巨大甲状腺肿手术切除技巧及注意事项.肿瘤基础与临床，2019,32(1):68-70.
[3]Le QV,Nguyen HV,Mai NTK,et al.Surgical treatment result of giant thyroid tumor:case series in Vietnam.Int J Surg Case Rep,2019,54:103-107.
[4]孙辉,刘晓莉.甲状腺术后窒息原因与处理.中华普外科手术学杂志:电子版，2013，7(4):254-257.
[5]孙燕翔,冯煜,刘兆龙,等.巨大甲状腺肿手术术中喉返神经保护策略.中国临床医学,2019,26(3):508-510.
[6]Gao B,Tian W,Jiang Y,et al.Perioperative treatment of giant nodular goiter.Int J Med Sci,2012,9(9):778-785.
[7]周京安,骆成玉,李洋.超声刀联合双极电凝镊在腔镜辅助甲状腺癌手术中的应用.中国微创外科杂志,2022,22(1):26-30.
[8]胡洪生,孙少华,沈丰,等.术前应用复方碘溶液对非毒性巨大甲状腺肿手术的影响.中国现代普通外科进展,2018,21(5):365-368.
[9]何端军,崔勇,唐建勇,等.气管受压甲状腺手术后外科呼吸危象的预防.解放军预防医学杂志,2018,36(8):1081-1083.
[10]Pan Y,Chen C,Yu L,et al.Airway management of retrosternal goiters in 22 cases in a tertiary referral center.Ther Clin Risk Manag,2020,12(16):1267-1273.
[11]Sajid B,Rekha K.Airway management in patients with tracheal compression undergoing thyroidectomy:a retrospective analysis.Anesth Essays Res,2017,11(1):110-116.

备注/Memo

备注/Memo:
*通讯作者，Email：luochengyu@163.com①麻醉科
更新日期/Last Update: 2022-10-11