摘要
该患者因“咳嗽、气促”入院。胸部平扫CT提示：上纵隔见约60 mm×42 mm的囊性灶，EBUS-TBNA术后患者咳嗽、气促明显改善，复查胸部CT病灶缩小至34 mm×24 mm，气管受压变窄移位较前明显缓解。
关键词
甲状腺囊肿临床较为常见，其大小不一，较小的甲状腺囊肿往往无症状，不需要治疗。但甲状腺囊肿较大、产生局部压迫症状或外观改变者，需要积极处理。超声支气管镜（endobronchial ultrasound，EBUS）已广泛应用于临
患者 女，50岁，农民。因“咳嗽、气促1个月余”于2020年8月14日入院。1个月余前患者无诱因开始出现刺激性干咳伴进行性活动性呼吸困难，无畏寒、发热、胸痛、咯血、胸闷、心悸、黑朦和晕厥等症状。
体温36.8℃，呼吸24次/min，脉搏86次/min，血压124/80 mmHg，呼吸稍促、口唇无紫绀，颈部气管居中，无明显三凹征，双侧颈部未扪及肿大的淋巴结，甲状腺可扪及，质偏硬，无压痛，表面欠光滑，可随吞咽上下移动，双侧甲状腺听诊无血管杂音，双肺呼吸音减弱，双肺未闻及明显干湿性啰音。心腹查体均正常。
血常规：白细胞6.66×1
图1 术前胸部增强CT
Fig.1 Preoperative enhanced chest CT
请甲状腺外科和血管外科会诊后，诊断为胸内巨大甲状腺囊肿，建议在全身麻醉下手术治疗，但该患者拒绝外科手术，遂于2020年8月17日在喉罩通气全身麻醉下行超声支气管镜检查。镜下所示：声门下方约3.5 cm气管左侧壁外压性隆起导致气管狭窄，狭窄长度约4.5 cm（
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图2 EBUS-TBNA前超细支气管镜镜下图像
Fig.2 Ultra-fine bronchoscope image before EBUS-TBNA
A：EBUS-TBNA前超细支气管镜近景镜下图像；B：EBUS-TBNA前超细支气管镜远景镜下图像
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图3 EBUS-TBNA术中及术后图像
Fig.3 Intraoperative and postoperative images of EBUS-TBNA
A：术中支气管超声图像；B：术后支气管镜镜下图像
经针吸抽液后患者咳嗽、气促明显改善。复查胸部CT提示：上纵隔左侧区囊性灶抽液术后，病灶范围约34 mm×24 mm。病灶较前明显缩小，气管受压变窄移位较前明显缓解。见
图4 术后复查胸部CT
Fig.4 Chest CT reexamined after needle aspiration
甲状腺囊肿是较为常见的良性病变，一般没有压痛，囊肿与周围组织之间没有明显粘
大多数甲状腺囊肿是由于结节性甲状腺肿或甲状腺腺瘤发生退行性变、出血或缺血坏死液化所致，部分为甲状腺腺瘤滤泡相互融合而形成，极少数来源于甲状舌管或后鳃体残余或甲状腺癌出血、坏
甲状腺囊肿治疗方式的选择主要取决于病变的位置与体积的大小，既往常采用手术切除。近年来，超声介入下硬化治疗以及射频消融等微创治疗，如局部抽吸和无水乙醇冲洗，既可减轻患者痛苦，又提供了令人满意的结果，但微创治疗主要适用于浅表小囊肿（直径 < 30 mm），术后可能发生继发性出血，且有复发的可能。治疗深部甲状腺囊肿（直径 > 30 mm），手术切除是首选方
综上所述，EBUS-TBNA治疗靠近气道的深部甲状腺囊肿是可行的。但其远期疗效和安全性仍需通过大样本临床研究进行验证。
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