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

Abstract

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.

Keywords

• Endemik Guatr,Tiroidektomi,Postoperatif Komplikasyonlar

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

Abstract

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

References

1. 1) Sözen S, Emir S, Alıcı A, Aysu F, Yıldız F, Aziret M, et al. Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü. Ulusal Cerrahi Dergisi 2010;26(1):13-7.
2. 2) Lombardi CP, Raffaelli M, De Crea C, Traini E, Oragano L, Sollazzi L, et al. Complications in thyroid surgery. Minerva Chir 2007;62(5):395-408.
3. 3) Acun Z, Cihan A, Ulukent S C. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;4(12):997-1001.
4. 4) Koutras DA, Matovinovic J, Vought R. The Ecology of Iodine. In: Stanbury JB, Hetzel BS, (eds) Endemic Goiter, Endemic Createnism. John Villey, New York, 1980;185-95.
5. 5) Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jørgensen T. Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur J Endocrinol 2000;142(3):224- 30.
6. 6) Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: e ff e c t o f c h a n g i n g p r a c t i c e . A r c h S u r g 1999;134(12):1389-93.
7. 7) Tezelman S, Borucu I, Senyurek Giles Y, Tunca F, Terzioglu 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(3):400-5.
8. 8) Marchesi M, Biffoni M, Tartaglia F, Biancari F, Campana FP. Total versus subtotal thyroidectomy in the management of multinodular goiter. Int Surg 1998;83(3):202-4.

9. 9) Colak T, Akca T, Kanık A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. S ANZ J Surg 2004;74(11):974-8 .
10. 10) Pappalardo G, Guadalaxara A, Frattaroli FM, IIIomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164(7):501-6.
11. 11) Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009;52(1):39- 44.
12. 12) Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24(11):1335-41.
13. 13) Jacobs JK, Aland JW Jr, Ballinger JF. Total thyroidectomy: A review of 213 patients. Ann Surg 1983;197(5):542-9.
14. 14) Özbaş S, Koçak S, Aydıntuğ S, Çakmak A, Demirkıran MA. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocrine Journal 2005;52(2):199-205.
15. 15) Yabanoğlu H, Aydoğan C, Sahillioğlu E. Evaluation of 213 thyroidectomy cases. Hakkari experience. Ulusal Cerrahi Derg 2011;27(4):212-5.
16. 16) Sosa JA, Bowman HM, Tielsch JM. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998;228(3):320-30.
17. 17) Filho JG, Kawalski LP. Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 2004;25(4):225-30.
18. 18) Bozdağ A. Multinodüler guatr tedavisinde total tiroidektomi deneyimimiz. Fırat Tıp Derg 2014;19(2):88- 90.
19. 19) Çıkman Ö, Özkul F, Arık MK, Taş Ş, Çakır C, Karaayvaz M. Endemik bölgede tiroidin benign hastalıklarında total tiroidektomi, 208 hastanın retrospektif analizi. Van Tıp Derg 2013;20(3):125-29.
20. 20) Castro MR, Gharib H. Thyroid nodules and cancer. When to wait and watch, when to refer. Postgrad Med 2000;107(1):113-6.
21. 21) Bozkurt K, Bektaş SS. The prevalence of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city. Dicle Medical Journal 2010;37(4):363-6.
22. 22) Polat Y, Sarıcık B, Berçin S, Koca YS, Polat HT. Tiroidektomi olgularımızın retrospektif analizi. Bozok Tıp Derg 2015;5(3):33-6.
23. 23) Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World J Surg 1988;12(4):449-53.