BİR EĞİTİM VE ARAŞTIRMA HASTANESİ GENEL CERRAHİ KLİNİĞİNDEKİ TİROİDEKTOMİ OLGULARININ RETROSPEKTİF ANALİZİ

Year 2019, Volume: 52 Issue: 1, 74 - 78, 14.03.2019

Yılmaz Ünal

Abstract

AMAÇ: Tiroidektomi genel cerrahi
kliniklerinde sık uygulanan bir prosedür olup deneyimli ellerde düşük morbidite
oranlarına sahiptir. Bu çalışmada bir eğitim ve araştırma hastanesinin genel
cerrahi kliniğinde tiroidektomi yapılan hastalara ait sonuçların retrospektif
olarak incelenmesi amaçlandı.

MATERYAL
VE METOD: Bu
çalışmaya S.B. Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde
Ağustos 2017-Eylül 2018 tarihleri arasında tiroid bezi hastalıkları nedeniyle
tiroidektomi yapılan 156 hasta dahil edildi. Hastaların demografik verileri,
ince iğne aspirasyon biyopsileri, ameliyat teknikleri, oluşan komplikasyonlar
ve patoloji sonuçları retrospektif olarak analiz edildi.

BULGULAR: Çalışmadaki toplam 156 hastanın
132’si(%84.6) kadın, 24’ü(%15.4) erkek idi. Hastaların ortalama yaşı 44.8, yaş
aralığı 21-77 idi. Hastaların hepsine preoperatif  ince iğne aspirasyon biyopsisi yapıldı.
Biyopsi sonuçları; 22 hastada nondiagnostik, 64 hastada benign, 26 hastada
önemi belirsiz atipi, 4 hastada foliküler neoplazi, 26 hastada malignite
şüphesi ve 14 hastada malign sitoloji şeklinde idi. Biyopsisi benign olan 64
hastanın, 10’unda(%15.6) patoloji sonucu papiller karsinom olarak raporlandı.
143 hastaya(%91.6) bilateral total tiroidektomi, 13 hastaya(%8.4) unilateral
total tiroidektomi(lobektomi+istmektomi) yapıldı. Ayrıca biyopsi sonucu malign
olan 8 hastaya bilateral total tiroidektomiye ilaveten unilateral boyun
diseksiyonu, 5 hastaya da santral boyun diseksiyonu yapıldı. Komplikasyonlara
bakıldığında hastaların 23’ünde(%14.7) geçici hipokalsemi, 1’inde(%0.6) kalıcı
hipokalsemi ,3’ünde(%1.9) geçici rekürren sinir hasarı, 3’ünde(%1.9) seroma ve
1’inde(%0.6) kanama görüldü. Kalıcı rekürren sinir hasarı hiçbir hastada
görülmedi.

SONUÇ: Rastlantısal malignite
oranlarının yüksekliğinden ve nüks olgulara yapılan ameliyatlarda komplikasyon
oranlarının yüksekliğinden dolayı nodüler guatr olgularında total
tiroidektominin uygun cerrahi teknik olduğu kanaatindeyiz.

Keywords

Guatr, Tiroidektomi, Komplikasyonlar

RETROSPECTIVE ANALYSIS OF THYROIDECTOMY CASES IN GENERAL SURGERY CLINIC OF A TRAINING AND RESEARCH HOSPITAL

Abstract

PURPOSE:Thyroidectomy
is a common procedure in general surgery clinics and has low morbidity rates in
experienced hands. The aim of this study was to retrospectively evaluate the
results of patients who underwent 
thyroidectomy in a general surgery clinic of a training and research
hospital.

 

MATERIAL
AND METHOD: A total of 156 patients who underwent
thyroidectomy for thyroid gland disease between August 2017 and September  2018 in Ankara Training and Research Hospital
General Surgery Clinic were included in this study. Demographic data, fine
needle aspiration biopsies, surgery techniques, complications and pathology
results were analyzed retrospectively.

RESULTS:132
(84.6%) of the patients were female and 24 (15.4%)of the patients were male.
The mean age of the patients were 44.8 years, and the age range were 21-77
years. All patients underwent preoperative fine needle aspiration biopsy.  Biopsy results are nondiagnostic in 22
patients, benign in 64 patients,insignificant atypia of undetermined
significance in 26 patients, follicullar neoplasia in 4 patients, malignancy
suspicion in 26 patients and malignant cytology in 14 patients. Of the 64
patients ,who had benign biopsy, pathology results  were reported as papillary carcinoma in 10
(15.6 %) patients.  Bilateral total
thyroidectomy was performed in 143 patients (91.6%) and unilateral total
thyroidectomy (lobectomy + isthmectomy) in 13 patients (8.4%). Unilateral neck
dissection was performed in addition to bilateral total thyroidectomy for the 8
patients who had malign biopsy results. Also central neck dissection was
performed in 5 patients who had malign biopsy results.   Complications were observed as temporary
hypocalcemia in 23 patients (14.7%), permanent hypocalcemia in 1 patient(0.6%),
temporary recurrent nevre injury in 3 patients (1.9%), seroma in 3 patiens
(1.9%), and hemoragia in 1 patient (0.6%). Permanent recurrent nevre injury was
not observed in any patient.

CONCLUSION: We
believe that total thyroidectomy is the appropriate surgical technique in
patients with nodular goiter because of the high rate of incidental malignancy
and high rate of complications in cases of reccurrence.

Keywords

Goiter, Thyroidectomy, Complications

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