Yılmaz ÜNAL

BİR EĞİTİM VE ARAŞTIRMA HASTANESİ GENEL CERRAHİ KLİNİĞİNDEKİ TİROİDEKTOMİ OLGULARININ RETROSPEKTİF ANALİZİ

AMAÇ: Tiroidektomi genel cerrahi kliniklerinde sık uygulanan bir prosedür olup deneyimli ellerde düşük morbidite oranlarına sahiptir. Bu çalışmada bir eğitim ve araştırma hastanesinin genel cerrahi kliniğinde tiroidektomi yapılan hastalara ait sonuçların retrospektif olarak incelenmesi amaçlandı. MATERYAL VE METOD: Bu çalışmaya S.B. Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde Ağustos 2017-Eylül 2018 tarihleri arasında tiroid bezi hastalıkları nedeniyle tiroidektomi yapılan 156 hasta dahil edildi. Hastaların demografik verileri, ince iğne aspirasyon biyopsileri, ameliyat teknikleri, oluşan komplikasyonlar ve patoloji sonuçları retrospektif olarak analiz edildi. BULGULAR: Çalışmadaki toplam 156 hastanın 132’si(%84.6) kadın, 24’ü(%15.4) erkek idi. Hastaların ortalama yaşı 44.8, yaş aralığı 21-77 idi. Hastaların hepsine preoperatif ince iğne aspirasyon biyopsisi yapıldı. Biyopsi sonuçları; 22 hastada nondiagnostik, 64 hastada benign, 26 hastada önemi belirsiz atipi, 4 hastada foliküler neoplazi, 26 hastada malignite şüphesi ve 14 hastada malign sitoloji şeklinde idi. Biyopsisi benign olan 64 hastanın, 10’unda(%15.6) patoloji sonucu papiller karsinom olarak raporlandı. 143 hastaya(%91.6) bilateral total tiroidektomi, 13 hastaya(%8.4) unilateral total tiroidektomi(lobektomi+istmektomi) yapıldı. Ayrıca biyopsi sonucu malign olan 8 hastaya bilateral total tiroidektomiye ilaveten unilateral boyun diseksiyonu, 5 hastaya da santral boyun diseksiyonu yapıldı. Komplikasyonlara bakıldığında hastaların 23’ünde(%14.7) geçici hipokalsemi, 1’inde(%0.6) kalıcı hipokalsemi ,3’ünde(%1.9) geçici rekürren sinir hasarı, 3’ünde(%1.9) seroma ve 1’inde(%0.6) kanama görüldü. Kalıcı rekürren sinir hasarı hiçbir hastada görülmedi. SONUÇ: Rastlantısal malignite oranlarının yüksekliğinden ve nüks olgulara yapılan ameliyatlarda komplikasyon oranlarının yüksekliğinden dolayı nodüler guatr olgularında total tiroidektominin uygun cerrahi teknik olduğu kanaatindeyiz.

Anahtar Kelimeler:

Guatr, Tiroidektomi, Komplikasyonlar

RETROSPECTIVE ANALYSIS OF THYROIDECTOMY CASES IN GENERAL SURGERY CLINIC OF A TRAINING AND RESEARCH HOSPITAL

PURPOSE:Thyroidectomy is a common procedure in general surgery clinics and has low morbidity rates in experienced hands. The aim of this study was to retrospectively evaluate the results of patients who underwent thyroidectomy in a general surgery clinic of a training and research hospital. MATERIAL AND METHOD: A total of 156 patients who underwent thyroidectomy for thyroid gland disease between August 2017 and September 2018 in Ankara Training and Research Hospital General Surgery Clinic were included in this study. Demographic data, fine needle aspiration biopsies, surgery techniques, complications and pathology results were analyzed retrospectively.RESULTS:132 (84.6%) of the patients were female and 24 (15.4%)of the patients were male. The mean age of the patients were 44.8 years, and the age range were 21-77 years. All patients underwent preoperative fine needle aspiration biopsy. Biopsy results are nondiagnostic in 22 patients, benign in 64 patients,insignificant atypia of undetermined significance in 26 patients, follicullar neoplasia in 4 patients, malignancy suspicion in 26 patients and malignant cytology in 14 patients. Of the 64 patients ,who had benign biopsy, pathology results were reported as papillary carcinoma in 10 (15.6 %) patients. Bilateral total thyroidectomy was performed in 143 patients (91.6%) and unilateral total thyroidectomy (lobectomy + isthmectomy) in 13 patients (8.4%). Unilateral neck dissection was performed in addition to bilateral total thyroidectomy for the 8 patients who had malign biopsy results. Also central neck dissection was performed in 5 patients who had malign biopsy results. Complications were observed as temporary hypocalcemia in 23 patients (14.7%), permanent hypocalcemia in 1 patient(0.6%), temporary recurrent nevre injury in 3 patients (1.9%), seroma in 3 patiens (1.9%), and hemoragia in 1 patient (0.6%). Permanent recurrent nevre injury was not observed in any patient. CONCLUSION: We believe that total thyroidectomy is the appropriate surgical technique in patients with nodular goiter because of the high rate of incidental malignancy and high rate of complications in cases of reccurrence.

Keywords:

Goiter, Thyroidectomy, Complications,

PDF

___

1. Güney E. Tiroid neoplazmları. Güney E, editör Tiroid ve Paratiroid Bez Cerrahi Hastalıkları. 1.Baskı. İstanbul: İyiişler matbaacılık Ltd Şti; 2008. s: 93-104.
2. Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jorgensen T. Thyroid structure and size and two-year follow-up solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur J. Endocrinol. 2000; 142: 224-30.
3. Süslü N, Hoşal Ş. Tiroid nodülüne yaklaşım ve cerrahi endikasyonlar. Türkiye Klinikleri J Surg. Med Sci. 2007: 3; 5-12.
4. Lombardi CP, Raffaelli M, De Crea C, et al. Complications in thyroid surgery. Minerva Chir. 2007; 62: 395-408.
5. Sözen S, Emir S, Alıcı A, ve ark. Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü. Ulusal Cerrahi Dergisi. 2010; 26: 13-7.
6. Ozbaş S, Koçak S, Aydintuğ S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, neartotal and total thyroidectomy in the surgical management of multinodular goitre. Endocr J. 2005; 52: 199-205.
7. Revelli L, Damiani G, Bianchi CB, et al. Complications in thyroid surgery Harmonic scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis. Int J Surg. 2016; 28: 22-32.
8. Smith RB, Coughlin A. Thyroidectomy Hemostasis. Otolaryngol Clin North Am. 2016; 49: 727-48.
9. Hannan SA. The magnificent seven: A history of modern thyroid surgery. Int J Surg. 2006; 4: 187-91.
10. Udelsman R, Chen H. The current management of thyroid cancer. Adv Surg. 1999; 33: 1-27.
11. Aires FT, Matos LL, Dedivitis RA, Cernea CR. Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic rewiev with meta-analysis. Rev Assoc Med Bras. 2018; 64: 649-57.
12. Giles Y, Boztepe H, Terzioğlu T, Tezelman S. The advantege of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg. 2004; 139: 179-82.
13. Acun Z, Comart M, Cihan A, Ulukent SC, Ucan B, Cakmak GK. Near-total thyrodectomy could be the best treatment for thyroid disease in endemic regions. Arch Surg. 2004; 139: 444-7.
14. Mobayen M, Baqhi I, Farzan R, Talebi A, Maleknia SA, Paknejad SA. Comparison of the results of total thyroidectomy and Dunhill operation in surgical treatment of multinodular goiter. Indian J Surg. 2015; 77: 1137-41.
15. Tezelman S, Borucu I, Senyürek Giles Y, Tunca F, Terzioğlu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg. 2009; 33: 400-5.
16. Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a rewiev of 932 cases. Can J Surg. 2009; 52: 39-44.
17. Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg. 1999; 134: 1389-93.
18. Polat Y, Sarıcık B, Berçin S, Koca YS, Polat HT. Tiroidektomi olgularımızın retrospektif analizi. Bozok Tıp Derg. 2005; 5: 33-6.
19. Kafadar MT. Endemik bir bölgede 940 tiroidektomi olgusunun değerlendirilmesi: Tek merkez, tek cerrah deneyimi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2016; 13: 207-14.
20. Colak T, Akca T, Kanık A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. ANZ J Surg. 2004; 74: 974-8.
21. Kuba S, Yamanouchi K, Hayashida N, et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: Comparative analysis after propensity score matching: A multicenter study. Int J Surg. 2017; 38: 143-8.
22. Ryu YJ, Cho JS, Yoon JH, Park MH. Identifying risk factors for recurrence of papillary thyroid cancer in patients who underwent modified radical neck dissection. World J Surg Oncol. 2018; 16: 205.
23. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated throid cancer. Thyroid. 2016; 26: 1-133.
24. Filho JG, Kawalski LP. Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol. 2004; 25: 225-30.
25. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: Analysis of a multicentric study on 14934 patients operated on in Italy over 5 years. World J Surg. 2004; 28: 271-6.
26. Reeve TS, Delbridge L, Brady P, Symth C. Seconder thyroidectomy: A twenty year experience. World J Surg. 1988; 12: 449-53.