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Vol. 33. Issue 2.
Pages 84-88 (February 1997)
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Vol. 33. Issue 2.
Pages 84-88 (February 1997)
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Tratamiento quirúrgico del bocio cervicomediastínico
Surgical treatment of cervicomediastinal goiters
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A. Álvarez Kindelán*, F. Cerezo Madueño, C. Baamonde Laborda, A. Salvatierra Velázquez, F. Javier López Pujol
Servicio de Cirugía Torácica. Hospital Regional Universitario Reina Sofía. Córdoba
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El objetivo de este estudio ha sido revisar nuestra experiencia en el tratamiento quirúrgico del bocio cervicomediastínico.

Se han estudiado retrospectivamente los pacientes con bocio cervicomediastínico operados en los últimos 10 años, analizando los datos relativos a sus antecedentes, clínica, métodos de diagnóstico, tratamiento quirúrgico y evolución postoperatoria.

Veintiocho pacientes, 19 mujeres y 9 varones, de 62 ± 2 años de edad se han incluido en el estudio. De los pacientes con clínica compresiva (75,6%), la disnea fue el síntoma más frecuente (36,6%), seguida de la disfagia y el síndrome de vena cava superior.

Sólo en 3 casos (11,2%) se evidenció un patrón funcional de obstrucción extratorácica. La gammagrafía mostró un aumento de tamaño del tiroides en 25 casos, de éstos, nueve presentaban además nodulo frío. La punción tiroidea se realizó en 5 enfermos, demostrando en uno malignidad.

Se realizó una fibrobroncoscopia en 15, encontrando compresión traqueal en 7 casos (25%). En éstos no hubo mayor incidencia de complicaciones postoperatorias.

En 23 casos (82,1%) se realizó una cervicotomía, una cervicosternotomía en cuatro (14%) y una toracotomía en uno (3,6%). En 15 pacientes (53,6%) se realizó tiroidectomía subtotal bilateral, total en tres (10,7%), derecha en seis (21,4%) e izquierda en cuatro (14,3%). El bocio coloide fue el tipo histológico más frecuente (42,8%), seguido de hiperplasia nodular (35,8%), cáncer (10,7%) y adenoma (10,7%).

En el postoperatorio, 3 pacientes presentaron paresia recurrencial transitoria, y otros 3 casos sufrieron complicaciones mayores: una hemorragia postoperatoria y 2 traqueomalacias que requirieron traqueotomía.

El bocio cervicomediastínico es una entidad que puede presentar síntomas compresivos traqueales y/o esofágicos. En nuestra serie, la mayor parte han sido resecables por cervicotomía, siendo más frecuentes los bocios coloides seguidos de la hiperplasia nodular. No hubo relación entre el tipo de tiroidectomía y la incidencia de complicaciones.

Palabras clave:
Bocio cervicomediastínico
Tiroidectomía
Complicaciones postoperatorias

To review our experience with the surgical treatment of cervicomediastinal goiters.

Charts of patients with cervicomediastinal goiters undergoing thyroidectomy within the last 10 years were reviewed. Data regarding previous disease, clinical features, diagnostic procedures, surgical intervention and postoperative evolution were recorded.

Twenty-eight patients (19 female and 9 male) 62 ± 2 years oíd underwent surgery to treat cervicomediastinal goiter during the period reviewed. Among patients with compressive manifestations (75.6%), dyspnea was the most common (36.6%) symptom, followed by dysphagia and superior vena cava syndrome. An extrathoracic obstruction pattern was found in 3 (11.2%) cases. Thyroid scintigraphy showed increased thyroid size in 25 patients, and in 9 of them a coid nodule was present as well. Fine needle aspiration of the thyroid gland was performed in 5 patients; malignancy was found only in 1 case. Fiberoptic bronchoscopy was performed in 15 patients; in 7 (25%) tracheal compression was found. In these patients there was no higher rate of postoperative complications.

Cervicotomy was the surgical approach used in 23 (82.1%) patients. Cervicosternotomy was used in 4 (14%), and thoracotomy in 1 (3.6%). The surgical procedure was bilateral subtotal thyroidectomy in 15 (53.6%), total thyroidectomy in 3 (10.7%), right lobectomy in 6 (21.4%), and left lobectomy in 4 (14.3%). Colloid goiter was the most common histological type (42.8%), followed by nodular hyperplasia (35.8%), cancer (10.7%) and adenoma (10.7%). Three patients showed transient recurrent paralysis in the postoperative period, and another 3 patients presented major complications: 1 case of postoperative bleeding and 2 cases of tracheomalacia requiring tracheostomy.

Cervicomediastinal goiter is a disease that may involve compressive symptoms. In our experience, most cases were resected through cervicotomy, colloid goiter and the nodular hyperplasia being the most common histological types. There was no relationship between surgical procedure and the incidence of complications.

Key words:
Cervicomediastinal goiter
Thyroidectomy
Postoperative complications
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Copyright © 1997. Sociedad Española de Neumología y Cirugía Torácica
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