Experience analysis of 27 cases of giant thyroid surgery
Objective To explore the surgical technique of giant thyroid and the prevention and treatment of its complica-tions.Methods Retrospective analysis was conducted on clinical data of 27 patients with giant thyroid admitted to the First Affiliated Hospital of Henan University from January 1,2015 to December 31,2022.All cases were divided into 4 kinds of operation methods:10 cases were treated with cervical incision in situ dissection;11 cases were treated with cervi-cal incision traction and lifting method;2 cases were treated with cervical collar incision combined with thoracoscopy;4 cases were treated with cervical thoracic combined with"T"incision.Results Total thyroidectomy was performed in 5 cases,unilateral lobectomy in 18 cases,and unilateral resection combined with contralateral subtotal resection in 4 ca-ses.Postoperative pathology:nodular goiter in 14 cases,Hashimoto's thyroiditis in 7 cases,adenomatous nodules in 4 ca-ses,adenoma with papillary carcinoma in 2 cases.The operative time of all patients was 120-240 min,and the median operative time was 180 min.Intraoperative blood loss was 20-340 ml,with a median of 50 mL.There were 4 cases of temporary hoarseness,3 cases of cough due to drinking water,3 cases of parathyroid autotransplantation and 5 cases of temporary hypoparathyroidism after operation,and all recovered to normal after calcium supplementation.All drainage devices were removed 3 to 13 days later,and the daily drainage flow was 10 to 100 ml.Eight patients were transferred to the intensive care unit due to preoperative dyspnea or severe trauma.All patients underwent tracheal intubation and extu-bation smoothly after operation.There were no cases of tracheal collapse and hyperthyroidism crisis.Twenty-seven cases were cured and discharged.No abnormality was found until December 31,2022.Conclusions It can improve the safety and reduce the difficulty of giant thyroid operation to adopt different surgical approaches.Operators should pay attention to fine operation and protect nerves,blood vessels,parathyroids,trachea and esophagus.
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