Tratamiento quirúrgico del bocio cervicomediastínico
Surgical treatment of cervicomediastinal goiters
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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Javier López Pujol" "autores" => array:5 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Álvarez Kindelán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Cerezo Madueño" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Baamonde Laborda" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Salvatierra Velázquez" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Javier López Pujol" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Torácica. Hospital Regional Universitario Reina Sofía. Córdoba" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Servicio de Cirugía Torácica. Hospital Regional Reina Sofía. Avda. Menéndez Pidal, s/n. 14004 Córdoba." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Surgical treatment of cervicomediastinal goiters" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1996-03-19" "fechaAceptado" => "1996-06-11" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec545640" "palabras" => array:3 [ 0 => "Bocio cervicomediastínico" 1 => "Tiroidectomía" 2 => "Complicaciones postoperatorias" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec545641" "palabras" => array:3 [ 0 => "Cervicomediastinal goiter" 1 => "Thyroidectomy" 2 => "Postoperative complications" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio ha sido revisar nuestra experiencia en el tratamiento quirúrgico del bocio cervicomediastínico.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se realizó una fibrobroncoscopia en 15, encontrando compresión traqueal en 7 casos (25%). En éstos no hubo mayor incidencia de complicaciones postoperatorias.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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%).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To review our experience with the surgical treatment of cervicomediastinal goiters.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 39 | 22 | 61 |
| 2024 September | 37 | 18 | 55 |
| 2024 August | 50 | 43 | 93 |
| 2024 July | 41 | 26 | 67 |
| 2024 June | 42 | 26 | 68 |
| 2024 May | 48 | 24 | 72 |
| 2024 April | 39 | 21 | 60 |
| 2024 March | 33 | 31 | 64 |
| 2024 February | 42 | 35 | 77 |
| 2024 January | 0 | 2 | 2 |
| 2023 December | 0 | 3 | 3 |
| 2023 November | 0 | 9 | 9 |
| 2023 October | 0 | 2 | 2 |
| 2023 September | 0 | 3 | 3 |
| 2023 July | 0 | 1 | 1 |
| 2023 March | 2 | 5 | 7 |
| 2023 February | 27 | 15 | 42 |
| 2023 January | 33 | 26 | 59 |
| 2022 December | 32 | 24 | 56 |
| 2022 November | 37 | 25 | 62 |
| 2022 October | 27 | 25 | 52 |
| 2022 September | 34 | 17 | 51 |
| 2022 August | 34 | 35 | 69 |
| 2022 July | 29 | 30 | 59 |
| 2022 June | 26 | 30 | 56 |
| 2022 May | 30 | 25 | 55 |
| 2022 April | 32 | 29 | 61 |
| 2022 March | 29 | 34 | 63 |
| 2022 February | 30 | 32 | 62 |
| 2022 January | 35 | 23 | 58 |
| 2021 December | 19 | 37 | 56 |
| 2021 November | 16 | 33 | 49 |
| 2021 October | 37 | 33 | 70 |
| 2021 September | 21 | 41 | 62 |
| 2021 August | 39 | 29 | 68 |
| 2021 July | 26 | 27 | 53 |
| 2021 June | 21 | 32 | 53 |
| 2021 May | 18 | 31 | 49 |
| 2021 April | 29 | 45 | 74 |
| 2021 March | 32 | 10 | 42 |
| 2021 February | 29 | 11 | 40 |
| 2021 January | 20 | 25 | 45 |
| 2020 December | 19 | 9 | 28 |
| 2020 November | 14 | 18 | 32 |
| 2020 October | 21 | 21 | 42 |
| 2020 September | 9 | 28 | 37 |
| 2020 August | 19 | 16 | 35 |
| 2020 July | 23 | 20 | 43 |
| 2020 June | 23 | 5 | 28 |
| 2020 May | 18 | 23 | 41 |
| 2020 April | 19 | 7 | 26 |
| 2020 March | 15 | 14 | 29 |
| 2020 February | 16 | 17 | 33 |
| 2020 January | 36 | 19 | 55 |
| 2019 December | 27 | 44 | 71 |
| 2019 November | 21 | 23 | 44 |
| 2019 October | 16 | 15 | 31 |
| 2019 September | 19 | 16 | 35 |
| 2019 August | 19 | 10 | 29 |
| 2019 July | 20 | 23 | 43 |
| 2019 June | 22 | 35 | 57 |
| 2019 May | 25 | 35 | 60 |
| 2019 April | 32 | 18 | 50 |
| 2019 March | 12 | 18 | 30 |
| 2019 February | 7 | 12 | 19 |
| 2019 January | 6 | 4 | 10 |
| 2018 December | 6 | 14 | 20 |
| 2018 November | 15 | 13 | 28 |
| 2018 October | 33 | 7 | 40 |
| 2018 September | 14 | 9 | 23 |
| 2018 May | 5 | 2 | 7 |
| 2018 April | 4 | 5 | 9 |
| 2018 March | 6 | 5 | 11 |
| 2018 February | 7 | 8 | 15 |
| 2018 January | 3 | 3 | 6 |
| 2017 December | 9 | 12 | 21 |
| 2017 November | 6 | 4 | 10 |
| 2017 October | 8 | 7 | 15 |
| 2017 September | 6 | 13 | 19 |
| 2017 August | 10 | 8 | 18 |
| 2017 July | 7 | 7 | 14 |
| 2017 June | 10 | 18 | 28 |
| 2017 May | 10 | 16 | 26 |
| 2017 April | 8 | 8 | 16 |
| 2017 March | 5 | 9 | 14 |
| 2017 February | 3 | 7 | 10 |
| 2017 January | 6 | 8 | 14 |
| 2016 December | 6 | 3 | 9 |
| 2016 November | 16 | 11 | 27 |
| 2016 October | 11 | 17 | 28 |
| 2016 September | 9 | 12 | 21 |
| 2016 August | 8 | 5 | 13 |
| 2016 July | 19 | 8 | 27 |
| 2016 June | 22 | 9 | 31 |
| 2016 May | 12 | 2 | 14 |
| 2016 April | 4 | 0 | 4 |
| 2016 March | 9 | 0 | 9 |
| 2016 February | 8 | 0 | 8 |
| 2016 January | 14 | 7 | 21 |
| 2015 December | 17 | 7 | 24 |
| 2015 November | 33 | 18 | 51 |
| 2015 October | 6 | 1 | 7 |
| 2015 September | 4 | 0 | 4 |
| 2015 August | 1 | 0 | 1 |
| 2015 June | 1 | 0 | 1 |
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