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Endemik Bir Bölgede 940 Tiroidektomi Olgusunun Değerlendirilmesi: Tek Merkez, Tek Cerrah Deneyimi

Amaç: Tiroidektomi tüm dünyada olduğu gibi, ülkemizde de genel cerrahi ve endokrin cerrahisi kliniklerinde en çok gerçekleştirilen ameliyatlardandır. Bu çalışmada, yeni uzman olmuş bir hekimin, endemik guatr bölgesi olan Bitlis ilindeki tiroidektomi deneyimlerinin irdelenmesi amaçlandı. Hastalar ve Yöntem: Bitlis Devlet Hastanesinde, Eylül 2008 ve Mart 2015 tarihleri arasında nodüler guatr ön tanısıyla cerrahi endikasyonu konulan ve tek cerrah tarafından tiroidektomi yapılan toplam 940 hasta retrospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, uygulanan cerrahi teknik, komplikasyonlar ve patoloji sonuçları açısından irdelendi. Bulgular: Hastalarımızın 827' si (%88) kadın, 113' ü (%12) erkek olup, kadın/erkek oranı 7,3/1 idi. Toplam 940 hastanın 30' una (%3,2) bir taraf total + diğer taraf totale yakın, 910' nuna (%96,8) bilateral total tiroidektomi uygulandı. Komplikasyonlara bakıldığında, 3 (%0,3) hastada kanama, 8 (%0,8) hastada yara yeri enfeksiyonu, 17 (%1,8) hastada seroma, 4 (%0,4) hastada sütür reaksiyonu, 58 (%6,1) hastada geçici hipokalsemi, 6 (%0,6) hastada kalıcı hipokalsemi, 13 (%1,3) hastada geçici rekürren sinir hasarı görüldü. 51 (%5,4) hastada malignite tespit edildi. Kalıcı rekürren sinir hasarı ve mortalite izlenmedi. Sonuç: Yapılan ameliyatların sayısının artması ve tecrübe kazanılmasıyla, total tiroidektominin kabul edilebilir komplikasyon oranları ile güvenle yapılabileceğine inanıyoruz. Nodüler guatr hastalarında total tiroidektomi, nüks ve reoperasyona bağlı komplikasyon ve malignite riskini ortadan kaldırdığı için tercih edilmelidir.

Anahtar Kelimeler:

Endemik Guatr, Tiroidektomi, Postoperatif Komplikasyonlar

Evaluation of 940 thyroidectomy cases in an endemic region: Single center, single surgeon experience

Objective: As in the most countries of the world including Turkey, thyroidectomy is one of the frequently performed surgeries in general surgery and endocrinology clinics. In this study, the discussion of the thyroidectomy experiences of a medical doctor who just completed his residency is intended in Bitlis city, the region where goiter is endemic.Material and methods: 940 patients with surgery indication according to nodular goiter diagnosis underwent thyroidectomy by a single surgeon were evaluated retrospectively at Bitlis State Hospital between September 2008 and March 2015. Patients were evaluated in terms of age, gender, surgical technique, complications and pathology results. Results: 827 of our patients (88%) were female and 113 (12%) were male. The proportion of female to male patients was 7,3/1. 30 of 940 patients (3,2%) underwent one part total and the other part near total thyroidectomy and 910 patients (96,8%) underwent total thyroidectomy. Regarding to complications, there were 3 patients (0,3%) with postoperative hematoma, 8 patients (0,8%) with wound infection, 17 patients (1,8%) with seroma, 4 patients (0,4%) with suture reaction, 58 patients (6,1%) with temporary hypocalcaemia, 6 patients (0,6%) with permanent hypocalcaemia, 13 patients (1,3%) with temporary recurrent nerve paralysis. At 51 patients (5,4%) malignancy was determined. Permanent recurrent nerve paralysis and mortality were not seen. Conclusion: We believe that total thyroidectomy can be performed safely with acceptable complication ratios as the surgery and experience rates increase. Total thyroidectomy should be preferred in patients with nodular goiter as it extinguishes the risks of recurrence and malignancy and complication risks of reoperation.

Keywords:

Endemic Goiter, Thyroidectomy, Postoperative Complications,

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