患者男性,60岁,农民,因发现右颈部肿块进行性增大4月,无声嘶及疼痛,于1986年3月6日入院.体检:右侧甲状腺Ⅱ度肿大,在其偏上方可及3×5cm 质地偏硬、能活动、表面呈结节状,周界不清肿块,拟诊:“右叶甲状腺癌?”定于3月14日上午行右侧腺叶全切及峡部切除术,术中见右叶甲状腺上极呈条索状向上延伸,高达舌骨水平,并左右分叉,分叉的内侧又分为三个分叉各有血管供应.分叉外侧再向上延伸,然后略呈水平位向外.粗细约0.5cm,初疑为甲状腺上静脉,但扪之为实质感,沿此组织打开颈鞘.发现此甲状腺组织与颈内静脉紧贴,在进一步分离时,颈内静脉破裂造成出血,暂时给予阻断,最后将甲状腺与颈内静脉分开.结果发现颈内静脉内侧壁有一缺损约1.5×0.5cm~2。甲状腺组织与颈内静脉壁完全粘贴一起,无法分开.切除甲状腺后,静脉破裂口用无损伤线修补.术后病理报告:结节性甲状腺肿. The patient was male, 60 years old, and the farmer suffered an increase in the right neck mass for 4 months. He had silent hearing loss and pain. He was admitted to hospital on March 6, 1986. Physical examination: The right side of the thyroid gland was enlarged in the second degree, and was located on its upper side. And 3 × 5cm texture is hard, can be active, the surface was nodular, the surrounding mass is not clear, would be diagnosed: “right thyroid cancer?” On the morning of March 14th, the right lobectomy and isthmic resection During the operation, the upper right thyroid gland showed an upward extension of the cord, reaching up to the level of the hyoid bone, and left and right bifurcations. The inside of the bifurcation was divided into three bifurcations and each had its own blood supply. Lateral extension of the bifurcation then extended. Then slightly horizontal outward. Thickness of about 0.5cm, initially suspected as an upper thyroid vein, but the phlegm is a sense of substance, open the neck sheath along this tissue. This thyroid tissue was found close to the internal jugular vein, in the further separation, The rupture of the internal jugular vein resulted in hemorrhage, temporary blockage was given, and finally the thyroid gland was separated from the internal jugular vein. As a result, it was found that the internal jugular vein had a defect of approximately 1.5 x 0.5 cm-2. The thyroid tissue is completely affixed with the internal jugular vein wall and cannot be separated. After the thyroidectomy, the venous rupture port is repaired with a non-injured line. Postoperative pathology report: nodular goiter.