Surgical therapy of goiter plunged in the mediastinum. Considerations regarding our experience with 165 patients.
Thyroid goiter is called plunged when, starting from the cervical region, it grows in the anterior-superior mediastinum to a depth of more than 2 cm. The highest frequency (48.44%) is evident in the age range from 60 to 70. From February 2002 to August 2005, performed 133 (80.6%) near total thyroidectomies, 26 total thyroidectomies (15.7%), 4 lobectomies (2.4%) and 2 (1.2%) totalisations of recurrences for plunged goiter in the 7th Division of General Surgery of the Second University of Naples. The goiters were classified using Lamke and Ferrante's topographical classification, which distinguishes between prevascular and retrovascular cervico-mediastinal goiters depending on the position assumed by the part plunged in the mediastinum in relation to the vascular layer of the epiaortic trunks. Retrovascular goiters are further subdivided into: pre-tracheal, laterovisceral and retrovisceral goiters depending on the relation to the trachea, oesophagus and epiaortic trunks. Among the patients who underwent near total thyroidectomy, there were 3 cases of permanent hypocalcaemia, 7 (7.2%) of temporary hypocalcaemia and only 1 (0.6%) monolateral temporary recurrent nerve lesion. Among those who underwent total thyroidectomy there was 1 case (0.6%) of temporary hypocalcaemia, and 1 (0.6%) of permanent hypocalcaemia. Postoperatively we also observed 3 cases (1.8%) of haemorrhage and 3 (1.8%) transfers to intensive care for respiratory insufficiency; 1 of these patients died 25 days after the operation. Ligature of the inferior and superior thyroid artery near the thyroid capsule protects the vascularisation of the parathyroid glands as well as the recurrent nerve and its division branches.
Candela
Giancarlo
G
VII Division of General Surgery, Second University of Naples, Naples.
Varriale
Sergio
S
Di Libero
Lorenzo
L
Manetta
Fiorenza
F
Giordano
Marco
M
Maschio
Antonio
A
Civitillo
Fabio
F
Pizza
Alessandra
A
Napolitano
Salvatore
S
Lanza
Michele
M
Argenziano
Giacomo
G
Sciascia
Valerio
V
Casaburi
Vincenzo
V
D'Aniello
Francesco
F
Varriale
Roberto
R
Santini
Luigi
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006042:Goiter / Q000145:classification*; D006045:Goiter, Substernal / Q000601:surgery*; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011183:Postoperative Complications; D013965:Thyroidectomy