术中发现气管憩室2例病例报告并文献复习

doi:10.16139/j.1007-9610.2023.04.016

摘要/Abstract

摘要：

分析甲状腺肿瘤相关诊疗中气管憩室易漏诊或误诊的原因，加强对该疾病临床特点的认识。检索国内、外近20年相关文献，分析类似病例中发生误诊、漏诊的原因，并就解剖学、鉴别诊断、检查方式进一步剖析。同时对近期2例在术中发现的气管憩室临床病例与其相关的临床资料进行回顾性分析。气管憩室易与甲状腺肿物相混淆，被误诊的原因如下：气管憩室在大多数病人中并无症状；有症状的气管憩室与甲状腺结节也有着类似的临床症状；许多气管憩室的影像学表现缺乏特征性。普外科医师应提高对气管憩室的认知、提高临床工作的警惕性；应将颈部CT列为甲状腺腺叶切除相关手术术前的常规检查。

关键词: 气管憩室, 甲状腺肿瘤, 甲状腺癌根治术

Abstract:

To analyze the reasons why tracheal diverticula is easy to be missed or misdiagnosed in the diagnosis and treatment of thyroid tumors, and to strengthen the understanding of the clinical characteristics of the disease. The reasons of the misdiagnosis and missed diagnosis in similar cases were analyzed, and the anatomy, differential diagnosis, and examination methods by reviewing the relevant literature in the past 20 years were further analyzed. At the same time, a retrospective analysis was carried out on two recent clinical cases of tracheal diverticula discovered during surgery. Tracheal diverticula is easily confused with thyroid tumor and may be misdiagnosed for the following reasons: tracheal diverticula is asymptomatic in most patients; symptomatic tracheal diverticula has similar clinical symptoms to thyroid nodules; lack of character in imaging findings. General surgeons should improve their awareness and vigilance of tracheal diverticula. Neck CT should be listed as a routine examination before thyroid-related surgery.

Key words: Tracheal diverticula, Thyroid tumor, Radical thyroidectomy

中图分类号:

R736.1

贺文, 顾建华, 邢戌健, 翁子毅, 费健. 术中发现气管憩室2例病例报告并文献复习[J]. 外科理论与实践, 2023, 28(04): 383-387.

HE Wen, GU Jianhua, XING Xujian, WENG Ziyi, FEI Jian. Tracheal diverticula discovered during surgery: a report of 2 cases and literature review[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 383-387.

图/表 4

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表1

颈-上胸部病灶为TD的病例报道及特征

Author	Age(year)/ sex	Location	Size(mm)	Symptoms	Primary diagnosed	Actual diagnosis	Discovered ways	Treatments	Adverse events	Follow-up
Kim, et al^[10] 2021	68/F	On the right side of the trachea at the level of the thoracic inlet	21×19	Protruding neck mass causing neck swelling, neck discomfort, and sore throat	TD	TD	CT scan and histopathological examination	Aspirate to reduce volume by 21-gauge syringe needle; the mass was excis	None	There were no postoperative complications after 6 months
Wang et al^[11], 2020	47/M	Right posterior carina	2	None	NA	TD	Tracheal inspection and CT scan before thoraco-scopic lobectomy	The operation was suspended for follow-up obser-vation with anti-inflammatory treatment	NA	A month later, there was no significant change in chest CT as compared with the past one month
Sun， et al^[12] 2019	49/F	Right posterior side of the trachea	18×10×3	Pain in the right neck with fever	Inflammation	TD	MRI examination after ineffective anti-inflammatory treatment	Surgical resection	None	Disappearance of clinical symptoms
Zhang， et al^[13] 2019	61/F	Right posterior side of the trachea	13×11	Shortness of breath, and intermittent stabbing pain in the right supraclavicular fossa	Thyroid no-dules	TD	FNA,CT and X-rays with barium	NA	None	NA
Ellis, et al^[14] 2019	20s/M	Right posterior side of the trachea	43×18	Night sweats and dyspnoeic	lymphoma	TD	CT scan of the chest and fibre-optic bronchoscopy.	Surgical resection	None	NA
Toscano, et al^[5] 2019	26/M	Right posterior side of the trachea	15	Recurrent respiratory tract infections and repeated episodes of haemoptysis during asthma treatment	Complications of asthma	TD	CT scan and inntra-operative exploration	Surgical resection	72 hours after surgery with minor dysphonia	Two months after surgery, the patient was asymptomatic
Tanaka, et al^[15] 2018	76/M	Right posterolateral region of the trachea, between the right cervical paraesophageal lymph nodes and the right RLN lymph nodes	10	None	Lung bullae and an esophageal diverticula	TD	An esophageal diverticula was ruled out by esophagography, and lung bullae were ruled out by CT. The tracheal diverticula could be observed through the cervical incision during thoracoscopic esophagectomy	Follow-up	NA	NA
Lin， et al^[16] 2014	44/M	Right posterior side of the trachea	3	Repeatedly coughing with white phlegm	Inflammation	TD	H-RCT scan and the tracheal reconstruction after ineffective anti-inflammatory treatment	Surgical resection	Delay	NA
Lasker, et al^[17] 2016	60/F	Right posterior side of the trachea	20×18×15	None	NA	TD	Surgical finding	Surgical resection	None	NA
Xing, et al^[18] 2003	40/F	Right posterior side of the trachea	10×10	Chest tightness, dry cough, painless swelling in the neck	Tuberculosis	TD	CT scan and fibre-optic bronchoscopy after anti-tuberculosis treatment	Anti-inflammatory treatment	Delay	NA

表1

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