Multinodüler guatrlarda total ve subtotal tiroidektominin erken dönem komplikasyonlarının karşılaştırılması
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Çalışmamızda ocak 2005-aralık 2009 tarihleri arasında Dicle üniversitesi tıp fakültesi genel cerrahi kliniğinde multinodüler guatr nedeniyle tiroidektomi uygulanan 419 hastanın bulguları retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, ameliyat endikasyonları, preoperatif antitiroid ilaç kullanımı, yapılan ameliyat çeşidi, erken dönem morbidite (geçici ve kalıcı rekürren laringeal sinir hasarı, geçici ve kalıcı hipokalsemi, postoperatif kanama ve yara yeri enfeksiyonu) ve hastanede kalış süreleri değerlendirildi. Hastalar total ve bilateral subtotal tiroidektomi olmak üzere iki gruba ayrıldı. Soliter adenom veya toksik adenom nedeniyle tek tarafa lobektomi uygulanan hastalar, tiroid kanseri nedeniyle tiroidektomi yapılan hastalar, malignite veya rekürren guatr nedeniyle tamamlayıcı tiroidektomi yapılan hastalar çalışma dışı bırakıldı. Hastaların yaş ortalamaları 41,72 (±12,55) olup, hastaların 329'u (%78,5) kadın, 90'ı (%21,5) erkek idi. 301 (%71,9) hasta multinodüler guatr, 118 (%28,1) hasta toksik multinodüler guatr nedeniyle opere edildi. 263 (%62,8) hastaya total tiroidektomi, 156 (%37,2) hastaya subtotal tiroidektomi uygulandı. Total tiroidektomi yapılan 6 (%2,3) hastada, subtotal tiroidektomi yapılan 3 (%1,9) hastada rekürren laringeal sinir hasarı saptandı. Subtotal tiroidektomi yapılan grupta kalıcı rekürren laringeal sinir hasarı gözlenmezken, total tiroidektomi yapılan grupta 1 (%0.4) hastada kalıcı rekürren laringeal sinir hasarı gözlendi. Total tiroidektomi yapılan 40 (%15,2) hastada hipokalsemi gözlenirken, subtotal tiroidektomi yapılan 27 (%17,3) hastada hipokalsemi gözlendi. Subtotal tiroidektomi grubunda kalıcı hipokalsemi gözlenmezken, total tiroidektomi grubunda 1 (%0.4) hastada kalıcı hipokalsemi görüldü. Subtotal tiroidektomi yapılan 3 (%1,9) hastada hematom, 1 (%0,6) hastada yara yeri enfeksiyonu ve total tiroidektomi yapılan 3 (%1,1) hastada hematom, 3 (%1,1) hastada yara yeri enfeksiyonu gelişti. Çalışmamızda total tiroidektomi ile subtotal tiroidektomi arasında postoperatif komplikasyonlar açısından anlamlı bir farklılık bulunmadı. Çalışmamız total tiroidektominin her iki lobu da tutan multinodüler guatrlarda düşük komplikasyon oranı ile güvenli bir şekilde uygulanabileceğini desteklemektedir. Anahtar kelimeler: multinodüler guatr, tiroidektomi, komplikasyonlar
In our study, the findings of 419 patients operated due to multinodulary goitre between January 2005 - December 2009 in Dicle University Medical School General Surgery Clinic were retrospectively evaluated. Patients' demographic characteristics, operative indications, preoperative antithyroid drug usage, the operation type, early morbidity and length of hospital stay were evaluated. According to the operation type, patients were divided into two groups as total thyroidectomy and bilateral subtotal thyroidectomy. Patients who underwent unilateral lobectomy because of a solitary adenoma or a toxic adenoma were excluded from the study as well as the ones who underwent thyroidectomy because of thyroid cancer and completion thyroidectomy for malignancy or recurrent goiter. The mean age of patients was 41.72 (± 12.55). 329 patients (78.5%) were women and 90 (21.5%) were men. 301 patients (%71.9) were operated for multinodulary goitre and 118 patients (%28.1) for toxic multinodulary goitre. 263 patients (%62.8) underwent total thyroidectomy and 156 (%37.2) patients underwent subtotal thyroidectomy. 6 (2.3%) of total thyroidectomy patients and 3 (1.9%) of subtotal thyroidectomy patients had recurrent laryngeal nerve injury. Subtotal thyroidectomy group revealed no permenant damage whereas in total thyroidectomy group 1 (%0.4) patient did. Hypocalcemia was observed in 40 patients (%15.2) in the total thyroidectomy group and in 27 (%17.3) patients in the subtotal thyroidectomy group. 1 (%0.4) patient in total thyroidectomy group suffered from permenant hypocalcemia whereas it wasn’t observed in subtotal thyroidectomy group. Haematoma occured in 3 (%1.9) patients treated with subtotal thyroidectomy and in 3 (%1.1) treated with total thyroidectomy, wound infection occured in 1 (%0.6) patient subjected to subtotal thyroidectomy and 3 (%1.1) patients treated with total thyroidectomy. In our study, no significant difference between total and subtotal thyroidectomy was found in terms post operative complications. In conclusion, our study supports total thyroidectomy for multinoduler goitre involving both lobes as a safe technique with low complication rate. Key words: multinodulary goitre, thyroidectomy, complications.
In our study, the findings of 419 patients operated due to multinodulary goitre between January 2005 - December 2009 in Dicle University Medical School General Surgery Clinic were retrospectively evaluated. Patients' demographic characteristics, operative indications, preoperative antithyroid drug usage, the operation type, early morbidity and length of hospital stay were evaluated. According to the operation type, patients were divided into two groups as total thyroidectomy and bilateral subtotal thyroidectomy. Patients who underwent unilateral lobectomy because of a solitary adenoma or a toxic adenoma were excluded from the study as well as the ones who underwent thyroidectomy because of thyroid cancer and completion thyroidectomy for malignancy or recurrent goiter. The mean age of patients was 41.72 (± 12.55). 329 patients (78.5%) were women and 90 (21.5%) were men. 301 patients (%71.9) were operated for multinodulary goitre and 118 patients (%28.1) for toxic multinodulary goitre. 263 patients (%62.8) underwent total thyroidectomy and 156 (%37.2) patients underwent subtotal thyroidectomy. 6 (2.3%) of total thyroidectomy patients and 3 (1.9%) of subtotal thyroidectomy patients had recurrent laryngeal nerve injury. Subtotal thyroidectomy group revealed no permenant damage whereas in total thyroidectomy group 1 (%0.4) patient did. Hypocalcemia was observed in 40 patients (%15.2) in the total thyroidectomy group and in 27 (%17.3) patients in the subtotal thyroidectomy group. 1 (%0.4) patient in total thyroidectomy group suffered from permenant hypocalcemia whereas it wasn’t observed in subtotal thyroidectomy group. Haematoma occured in 3 (%1.9) patients treated with subtotal thyroidectomy and in 3 (%1.1) treated with total thyroidectomy, wound infection occured in 1 (%0.6) patient subjected to subtotal thyroidectomy and 3 (%1.1) patients treated with total thyroidectomy. In our study, no significant difference between total and subtotal thyroidectomy was found in terms post operative complications. In conclusion, our study supports total thyroidectomy for multinoduler goitre involving both lobes as a safe technique with low complication rate. Key words: multinodulary goitre, thyroidectomy, complications.
Açıklama
Anahtar Kelimeler
Multinodüler guatr, Multinodulary goitre, Tiroidektomi, Thyroidectomy, Komplikasyonlar, Complications
