Before the Spring Festival, we have a 90 year old woman to do bilateral thyroid gland lobectomy. The old lady's thyroid gland is very large,
Before the Spring Festival, we have a 90 year old woman to do bilateral thyroid gland lobectomy. The old lady's thyroid gland is very large, three years ago to open, but because the age is too large, there is no surgery. This time, the old lady can not stand, bilateral thyroid side is 15cm, one side is 12cm, the trachea pressure into a line, causing breathing difficulties, breathless, chest tightness, was admitted to the Department of Cardiology ICU. When I went to the consultation, I told her family that the operation had a great risk, not the difficulty of the operation, but the fear of cardiovascular and cerebrovascular accident after surgery, but not surgery may be due to respiratory failure and death. After repeated deliberation, her family finally decided to undergo surgery. We had a full preparation before the operation. When the operation is the use of tracheal intubation general anesthesia, can ensure the airway patency. In the operation, we close the membrane of the thyroid gland and dissect the bilateral recurrent laryngeal nerve. The intact parathyroid glands and their feeding arteries were reserved to avoid the occurrence of hypoparathyroidism and low calcium. After cutting the bilateral lobes, we found that, as we had expected, the old woman's trachea collapsed and the tracheal cartilage ring broke into several segments. So we put the old lady's trachea suture hanging in front of the neck muscles, and tracheotomy. After the operation to give phlegm, anti-inflammatory treatment, the old lady recovered very smoothly, no symptoms of low calcium, after intubation can be free speech, there is no choking cough. Two weeks after the operation, the trachea was removed, the old lady breathed normally and the speech was very good.
Over the past two years, I have done a lot of thyroid gland lobectomy, and few cases of postoperative hypocalcemia or nerve damage. My experience is the time of surgery was close to the thyroid membrane separation is very important, I do not agree with the so-called retention after resection of the thyroid gland and gland tissue envelope clamp method. In my opinion, the so-called safe operation method is not safe, because the depth of Schnabel is very blind, after the removal of suture is to let people heart once suture deep, always on tenterhooks, it may cause nerve damage. I just do thyroid resection I also used to cut technology now, completely free to remove part of the precise excision, rather than blindly was cut up.
For the protection of parathyroid glands, my experience is to protect the integrity of the blood supply is the key to avoid postoperative low calcium. In general, for benign thyroid disease, thyroid is close to the membrane separation, retains its surrounding connective tissue, can protect the blood supply of parathyroid glands and its effective, but not necessary to confirm anatomy of parathyroid glands. The rapid pathological check suspicious mass delivery during the operation, if it is malignant, which underwent central lymph node dissection, can obtain good therapeutic effect.