Benign nodüler guatrda cerrahi yaklaşım; 72 olgunun analizi

Benign nodüler guatrlı hastaların tedavisinde cerrahi rezeksiyon sıklıkla uygulanmaktadır. Ancak benign nodüler guatıra cerrahi yaklaşımda tiroidektominin genişliği halen tartışmalıdır. Kızıltepe Devlet Hastanesi Kulak Burun Boğaz Servisi’nde Nisan 2002-Temmuz 2007 tarihleri arasında toplam 72 hastaya tiroid cerrahisi uygulandı. Hastaların 63’ü kadın (%87.5), 9’u erkekti (%12.5). Otuzdokuz hastaya tek taraflı total lobektomi+istmusektomi (%54.2) , 20 hastaya totale yakın tiroidektomi (%27.8),11 hastaya bir taraf total lobektomi+istmusektomi+ karşı tarafa subtotal tiroid lobektomi (Dunhill prosedürü) (%15,3) , iki hastaya total tiroidektomi (% 2.7) yapıldı. Postoperatif 3 hastada seroma ( % 4.1), 2 hastada eksplorasyon gerektirecek postoperatif hematom (%2.7), 1 hastada sütür reaksiyonu (%1.3), saptandı. Hastalarımızda geçici veya kalıcı nervus laringeus rekürren hasarı, hipoparatiroidi ve infeksiyon saptanmadı. Sonuç olarak benign nodüler guatrın cerrahi tedavisinde mümkün olduğunca geniş cerrahi yöntemler tercih edilmelidir. Soliter nodüllerde total lobektomi + istmusektomi, multinodüler guatrda kalan doku sağlamsa Dunhill prosedürü, sağlam değilse totale yakın veya total tiroidektomi tercih edilmelidir.

Surgical treatment of benign nodular goiter; report of 72 patients

Surgical resection is usually prefered for the treatment of benign nodular goiter. But the extention of thyroidectomy in the surgical management of benign nodular goiter still remains controversial. Seventytwo patients underwent thyroid surgery between April 2002- July2007 in Kızıltepe State Hospital Otorhinolaryngology Service. Of the patients 63 were women (%87.5), 9 were man (%12.5). The range of age was between 15-62 years and mean age was 36,5. Thirtynine patients had unilateral total lobectomy+ istmusectomy (%54.2), 11 patients had unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill Procedure) (%15.3), 20 patients had nearly total thyroidectomy (%27.8), 2 patients had total thyroidectomy (% 2.7). Three patients had seroma (%4.1), 2 patients had hemorrhage requiring operative hemostasis (%2.7), 1 patient had suture reaction(%1.3). Patients have not had permanent or temporary nervus laryngeus recurrens injury, hypoparathyroidism and infection. As a result more extent surgical resections must be preferred by the surgeon for the treatment of benign nodular goiter. The preferable surgical treatment of solitary nodules is lobectomy+isthmusectomy. The multinodular goiter must be treated with unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill procedure) when the remnant thyroid tissue is normal; otherwise nearly total or total thyroidectomy is preferable.

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