Surgical Management For Substernal Goiter With Cervical Collar Incision

Objective: To study the diagnosis and surgical management for substernal goiter with cervical collar incision. Methods: The clinical data of 40 patientswith substernal goiter in this hospital from 2002 to 2009 were retrospectively analyzed. The preoperative exmination?surgical modality and the postoperativecomplications were reviewed. Results: The median age of the 40 patients (11women and 26 men) was 64 years, with a range of 48 to 80years. The main symptoms of substernal goiter patients were cervical mass (24/40) , airway obstraction (17/40) , hyperthyroidism (2/40) , hoarseness (2/40) and choke (5/40) . The sensitivity of chest X-ray, ultrasonography, CT, and scintigraphy was 61. 1%, 19. 2%, 85. 7%,和78. 2% respectively. The substernal goiter was divided into three types to based on chest film, computed tomography imaging and clinical sympyom. I type: the inferior extremity of goiter is on the aortic arch. II type is the goiter to inter intrathoracic and portion located behind aortic arch, or the goite enter posterior mediastinum. ForⅢtype, intrathoracic goiter intrude thoracic cavity, or accompany superior vena caval syndrome. All 40 cases (I type 28 cases?II type 10 cases?Ⅲtype 2 cases) were performed by cervical incision. Phthology identified benignity in 37, malignancy in 3. Conclusion: Most cases of substernal goiter can be managed by cervical incision. The approach is applicable with the advantages of mini - wound and rapid recovery.