Sadullah GİRGİN, Metehan GÜMÜŞ, Akın ÖNDER, Murat KAPAN

Tamamlayıcı tiroidektomi: Tek merkez sonuçları

Amaç: Tamamlayıcı tiroidektomi, ya nüks nodüler guatr yada ameliyat sonrası histopatolojik olarak malignite durumlarında gereklidir. Bu çalışmada amacımız tamamlayıcı tiroidektomi uygulanan hastalarda operasyon endikasyonlarını, ameliyat zamanlamasını ve morbiditesini araştırmaktır. Gereç ve Yöntem: Ocak 2004-Ekim 2008 tarihleri arasında tamamlayıcı tiroidektomi ugulanan 31 hasta retrospektif olarak incelendi. Çalışmaya benign nodüler guatr tanısıyla opere edilip histopatolojik değerlendirme sonucunda kanser saptanan veya nüks nodüler guatr nedeniyle ikinci ameliyata gereksinim duyan hastalar dahil edildi. Bulgular: Hastaların yaş ortalaması 36.5±7.7 (23-55) yıl olup, 26 (%84)’sı kadın, 5 (%16)’i erkekti. On yedi (%55) hastaya ilk ameliyatından sonra 10 gün içinde veya 90 günden sonra (Grup 1), 14 (%45) hastaya 10-90 gün arasında (Grup 2) tamamlayıcı tiroidektomi uygulandı. Hastalarımızın ameliyat sonrası histopatolojik incelemelerinde toplam 7 hastada (%23) rezidü tümör saptandı, bunların ikisi (%6.5) karşı lobda idi. Ameliyat sonrası ta- kiplerde Grup 1’de bir hastada kalıcı hipoparatiroidizm, grup 2’de bir hastada kalıcı vokal kord paralizisine rastlandı. Sonuç: Verilerimiz tamamlayıcı tiroidektomi materyalinin histopatolojik incelemesinde %20’nin üzerinde rezidü tümör bulunması benign nedenlerle de total tiroidektomi dışında bir tedavi seçeneği uygulanmasının yeterli tedavi sağlamadığını düşündürmektedir. Tamamlayıcı tiroidektomi zamanlamasının komplikasyonlar üzerine önemli oranda etkisi saptanmadı. Tiroid kanseri veya benign nodüler guatrı olan hastalarda total tiroidektomi tercih edilebilir.

Completion thyroidectomy: Results of a single center

Aim: Completion thyroidectomy is required at situations such as recurrent nodular goiter and malignant findings at histopathology after primary operation for noduler goiter. The aim of this study was to investigate the indications for the completion thyroidectomy and the effect of the operation timing on morbidity. Materials and Methods: Thirty-one consecutive patients (26 females and 5 males) with a mean age of 36.5±7.7 years (range, 23-55 yrs) that underwent completion thyroidectomy were investigated. The patients, who needed re-operation for recurrence with diagnosis of histopathologically proven malignancy or re-operated for recurrence, were included. Results: Seventeen patients had the second operation performed within 10 days or more than 90 days after initial operation (group 1). Fourteen patients had re-operation between 10 and 90 days after the first procedure (group 2). Histopathological examination after the completion thyroidectomy revealed remnant tumour in 7 patients (23%), two of them in the contralateral lobe. One patient suffered from a permanent hypoparathyroidism in group 1 and a permanent vocal cord paralysis in group 2. Conclusion: Our results suggest that other treatment modalities except total thyroidectomy are insufficient, since remnant tumour was seen over 20% of the histopathological specimens of the completion thyroidectomy. Timing of completion thyroidectomy had no effect on the thyroid cancer development. Total thyroidectomy can be preferred in the surgical management of tiroid cancers or benign nodular goiter.

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