Faruk Kadri BAKKAL, Hakan TUTAR, Ahmet KÖYBAŞIOĞLU, Alper CEYLAN, Yusuf KIZIL, Utku AYDİL, Metin YILMAZ

Tiroid cerrahisi deneyimlerimiz

Amaç: Tiroid bezi cerrahisi yaptığımız olguları değerlendirmek vedeneyimlerimizi sunmak.Yöntem: Gazi Üniversitesi Tıp Fakültesi kulak boğaz burun kliniğinde 2008 ile2012 yılları arasında tiroidektomi yapılan 68 hasta çalışmaya alındı.Hastaların demografik özellikleri, patolojik tanıları, uygulanan cerrahiyöntemler, komplikasyonlar ve postoperatif klinik izlemleri retrospektifolarak kaydedildi.Bulgular: Hastaların 63ü primer, 5i revizyon hastadır. Hastaların 37 (%54)tanesi malign patoloji nedeniyle opere edilmiştir. En sık karşılaşılan patolojipapiller karsinom (%44) daha sonra nodüler guatrdır (%32). Tüm hastalardasinir monitörü rutin olarak uygulanmıştır. En sık uygulanan cerrahi yöntemtotal tiroidektomidir (%76). Eş zamanlı olarak 21 hastaya boyun diseksiyonu(%31), 1 hastaya mediastinal diseksiyon uygulanmıştır. Laringeal invazyonnedeniyle 2 hastaya total larenjektomi, senkron adenom varlığı nedeniyle 1hastaya da eş zamanlı paratiroidektomi yapılmıştır. İlk operasyonda boyundiseksiyonu yapılmayan 3 (%4) primer hastamıza, takiplerinde boyunda lenfnodu metastazı nedeniyle, boyun diseksiyonu yapılmıştır. Postoperatiferasyona sekonder vokal kord paralizisi izlenmemiştir.Sonuç: Tiroid patolojisi nedeniyle operasyonu planlanan hastalarınpreoperatif değerlendirmesi önemlidir. Operasyon sırasında sinirmonitörünün kullanılması rekürren laringeal sinir hasarını önemli ölçüdeazaltır. Klinik şüphe varlığında boyun diseksiyonunun primer cerrahi sırasındauygulanması ile boyun metastazları önemli ölçüde azaltılır.

Our experiences in thyroid surgery

Objective: To evaluate our thyroidectomy cases and present our experience. Methods: Sixty-eight thyroidectomy patients who were operated between 2008 and 2012 at Gazi University Faculty of Medicine, Ear Nose and Throat Department were included in the study. The demographic characteristics, pathological diagnosis, surgical procedures, complications, and postoperative clinical follow-up were evaluated retrospectively. Results: Of the patients 63 were primary and 5 were revision patients. Thirty- seven patients (54%) were operated for malignant pathology. The most common pathology was papillary carcinoma (44%) then nodular goiter (32%) was seen. Nerve monitor was routinely used in all operations. The most common surgical method is total thyroidectomy (76%). Of the 37 malignant patients 21 had concurrent neck dissection (57%) and one had mediastinal dissection. Total laryngectomy was performed for 2 patients due to laryngeal invasion and concurrent parathyroidectomy was performed for 1 patient due to synchronous parathyroid adenoma. Neck dissection was performed to 3 primary patients (8%) due to lymph node metastasis to the neck. Transient hypocalcemia (15%) was the most common complication in the postoperative period. None of the patients had vocal cord paralysis secondary to the surgery. Conclusion: Preoperative evaluation of patients with thyroid pathology is important. Recurrent laryngeal nerve injury could be decreased by the usage of nerve monitor routinely when neck dissection. As the presence of clinical suspicion, performing concurrent neck dissection with thyroidectomy may decrease the neck metastasis during follow-up significantly.

PDF

___

1. Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg 2003; 74: 437-43.
2. Tezelman S, Borucu D, Senyürek 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.
3. Sessions RB, Taylor T, Roller CA, OMalley B. Cancer of the thyroid gland. In: Harrison LB, Sessions RB, Hong WK, editors. Head and neck cancer. A multidisciplinary approach.Philadelphia: Lippincott-Raven; 1999.
4. Aslan S, Özer C, Erkan AN, Çaylaklı F, Akdoğan V, Yılmaz İ et al. Tiroid cerrahisi deneyimlerimiz. KBB ve BBC Dergisi 2009; 17: 96-100.
5. Shindo M, Chheda NN. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007; 133: 481-5.
6. Netterville JL, Aly A, Ossoff RH. Evaluation and treatment of complications of thyroid and parathyroid surgery. Otolaryngol Clin North Am 1990; 23: 529-52.
7.Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR,editors. Cummings Otolaryngology-Head and Neck Surgery. 4th ed. Philadelphia: Mosby;2005. p.2687-723.
8. Toprak D, Doğanay M, Kama NA. Complications after thyroid operations. Kocatepe Medicine Journal 2004; 5: 1-6.
9. Pfleiderer AG, Ahmad N, Draper MR, Vrotsou K, Smith WK. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl 2009; 91:140-6.
10. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987; 102: 1088-95.
11. Wad P, Berci G, Calcaterra TC. Superior laryngeal nerve paralysis, an often overlooked entity. Trans Am Acad Ophtalmol Otolaryngol 1977; 84:78-89.
12. ONeill JP, Fenton JE. The recurrent laryngeal nerve in thyroid surgery. Surgeon 2008; 6: 373-7.
13. Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: Voice, vocal cord function and the preoperative detection of invasive thyroid malignancy. Surgery 2006;139:357-62.
14. Lore J, Kim DJ, Elias S: Preservation of the laryngeal nerves during total thyroid lobectomy. Ann Otol Rhinol Laryngol 1977;86:777-8.
15. Toll EC, Loizou P, C. Davis CR, Porter GC, Pothier DD. Scars and satisfaction: Do smaller scars improve patient-reported outcome? Eur Arch Otorhinolaryngol 2012; 269: 309-13.
16. Akkoca M, Buluş H, Yavuz A, Aydın A, Koyuncu A, Coşkun A. Total tiroidektomi: klinik deneyimlerimiz. Ortadoğu Tıp Dergisi 2012; 4: 15-8.
17. Müller PE, Kabus S, Robens E, Spelsberg F. Indications, risks and acceptance of total thyroidectomy for multinodular benign goiter. Surg Today 2001; 31: 958-62.
18. Zambudio AR, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004; 240: 18-25.
19. Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447-63.
20. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ et al. American Thyroid Association Guidelines Task force. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109-42.