Mustafa YILMAZ, Suna ERKILIÇ, Umut ELBOĞA, Ebuzer KALENDER, Avni GÖKALP, Göktürk MARALCAN, Y. Zeki ÇELEN, Hasan Deniz DEMİR, Hüseyin KARAOĞLAN

Tamamlayıcı tiroidektomide gamma prob kullanımıyla ilgili başlangıç deneyimlerimiz

Gaziantep Üniversitesi Tıp Fakültesi Hastanesinde Haziran 2008 - Ekim 2010 tarihleri arasında tamamlayıcı tiroidektomi uygulanan 22 diferansiyel tiroid karsinomu olan olgu prospektif olarak incelenmiş, gamma prob ile yapılan cerrahi tedavinin sonuçları ele alınmıştır. İlk operasyonlarında subtotal veya totale yakın tiroidektomi uygulanmış, patoloji sonuçları iyi diferansiyel tiro id karsinomu gelen hastalara gamma prob destekli tamamlayıcı tiroidektomi uygulanmış, gamma probun etkinliği ortaya konulmaya çalışılmıştır. Preoperatif dönemde hastaların ortalama TSH değeri 1.48 mIU/l olarak tespit edildi. Ameliyattan 24 saat önce minimum 2 saat a çlık periyodundan sonra hastalara oral yolla 0.1 mCi sıvı I-131 verildi. Tiroid yatağından arka plan değeri üzerinde sinyal alınan tüm alanlar rezeke edildi. Operasyon başlangıcında arka plan ışıma değeri ortalama 24.04 cps (2-49), tiroid lojundan alınan bazal ışıma değeri ortalama 753.09 cps (29-5156) iken rezeksiyon sonrası lojdaki ışıma değerleri ortalama 13.4 cps (1-47) olarak ölçüldü. Postoperatif TSH kan seviyesi supresyon tedavisine başlanmadan önce ortalama 52.86 mIU/l olarak tespit edildi. Postoperatif dönemde tüm hastalarda (%100) tiroglobulin (Tg) seviyesi düştü. Gamma prob eşliğinde yapılan tamamlayıcı tiroidektominin daha etkin bir cerrahi rezeksiyon sağlayarak postoperatif tedavi ve takipleri kolaylaştırdığı, rekürrenslerin önlenmesinde en etkin yöntem olduğu görüşündeyiz.

Our initial experiences related to gamma probe use in completion thyroidectomy

In this study twenty two differentiated thyroid carcinoma (DTC) case performed completion thyroidectomy between June 2008 and October 2010 in Gaziantep University Medical Faculty Hospital were examined prospectively and surgical results of gamma probe were observed. Patients who had less then total thyroidectomy in their first operations with DTC pathology reports, went through gamma probe supported completion thyroidectomy, gamma probe efficiency was examined. In preoperative period, mean TSH value was identified as 1.48 mIU/l. 0.1mCi liquid I-131 was given to the patients after minimum 2 hours of starvation period one day before the day of surgery. All the areas where there was a signal over the background values were resected out from thyroid channel. While mean background radiation value was 24.04 cps (2-49) and mean basal radiation value of thyroid lodge was 753.09 cps (29-5156), after resection mean radiation value of thyroid lodge was measured as 13.4 cps (1-47). Postoperative TSH blood level before suppression therapy was measured as 52.86 mIU/l average. In post operative period all patients’ (100%) thyroglobulin levels decreased. In the operations supported by gamma probe, we did not observe any increase in complication rates compared to literature. These results suggest that completion total thyroidectomy with gamma probe makes post operative treatment and follow up easier by providing more efficient surgical resection, and also completion thyroidectomy with gamma probe is the most efficient method in avoiding recurrences.

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