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Substernal guatrlarda cerrahi

Year 2009, Volume 16, Issue 1, 1 - 5, 30.03.2009

Abstract

Süleyman Demirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2009 Mart; 16 (1) Substernal guatrlarda cerrahi Hasan Türüt*, Mehmet Sırmalı**, Göktürk Fındık***, Suat Gezer***, Gürhan Öz***, Koray Aydoğdu***, Irfan Taştepe***, Sadi Kaya***, Güven Çetin***. Özet Amaç: Substernal guatr nedeniyle cerrahi tedavi uygulanan hastaların klinik ve cerrahi açıdan analizi amaçlandı. Gereç ve Yöntem: Ocak 1996-Temmuz 2006 tarihleri arasında Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi Göğüs Cerrahisi Kliniğinde substernal guatr tanısı nedeniyle operasyon uygulanan 34 olgu retrospektif olarak incelendi. Olgular, yaş, cinsiyet, başvuru nedenleri, bulgular, cerrahi yaklaşımlar, postoperatif histopatoloji ve takip yönünden analiz edildi. Bulgular: Toplam 34 olgunun 19.u bayan, 15.i erkek olup ortalama yaş 57.5 (dağılım; 25-71) idi. En sık başvuru nedenleri respiratuar sistemle ilgili yakınmalar (nefes darlığı ve öksürük) idi. Olguların 28.i (%82.3) standart .Collar. insizyonu ile opere edilirken, geri kalan 6 olguda ek cerrahi prosedürlere (parsiyel/komplet medyansternotomi, torakotomi) gerek duyuldu. Postoperatif histopatolojik inceleme sonucu olguların, 29.unda (%85.2) tanı diffüz/nodüler kolloidal guatr olarak raporlanırken, 2 (%5.8) olguda malignite tespit edildi. Operasyon sonrası mortalite gözlenmezken, toplam morbidite oranı %17.6 idi. Sonuç: Substernal guatrlı hastalarda cerrahi yaklaşım önemli bir tedavi seçeneğidir. Olguların büyük bir kısmında servikal yaklaşım yeterli olmakla birlikte, endikasyon durumunda eklenecek parsiyel veya komplet medyan sternotomi ile intratorasik yerleşim gösteren anormal tiroid dokusu düşük morbidite ve mortalite ile rezeke edilebilir. Anahtar kelimeler: Substernal guatr, tiroid, tiroid cerahisi Abstract Surgical treatment of substernal goiters Objective: Our aim was to analyze the clinical and surgical aspects of the patients with substernal goiter.Materials and Methods: A total of 34 patients who underwent surgical treatment with the diagnosis of substernal goiter at Atatürk Chest Diseases and Chest Surgery Center between January 1996 and July 2005 were evaluated retrospectively. The patients were analyzed with respect to age, gender, presenting symptoms,findings, surgical procedures utilized, postoperative histopathology and follow-up. Results: Of the 34 patients, 19 were female and 15 were male with an age average of 57.5 years (range; 25-71). The most common symptom was related with respiratory system (dyspne and cough). A total of 28 patients (82.3%) were managed via standard .Collar. incision whereas the remain was required a total of 6 additional surgical procedures (partial/complete median sternotomy, thoracotomy). Of the 34 patients, 29 (85.2%) were diagnosed as diffuse/nodular colloidal goiter postoperatively; malignancy was detected in 2 (5.8%) of the patients. There was no operative mortality and our morbidity rate was 17.6%. Conclusion: The management of choice in patients with substernal goiter is to be surgical. Although servical incision is adequate in most of the patients, abnormal thyroid tissue can be resected via additional partial or complete mediansternotomy when indicated in patients with intrathoracic localisation with low morbidity and mortality rates. Key words: Substernal goiter, thyroid, thyroid surgery

References

  • Ýrfanoðlu ME, Abcý Ý, Hatipoðlu AR. Substernal guatrda cerrahi tedavi. Çaðdaþ Cerrahi Dergisi 2003;17:35-8.
  • Maruotti RA, Zannini P, Viani MP, Voci C, Pezzuoli G. Surgical treatment of substernal goiter. Int Surg 1991;76:12-7.
  • Erbil Y, Bozbora A, Barbaros U, Özarmaðan S, Azezli A, Molvalýlar S. Surgical management of substernal goiters: Clinical experience of 170 cases. Surg Today 2004;34:732-6.
  • Retrosternal goiters: safety of surgical treatment. Int Surg. 2003;88:205-10.
  • Armour RH. Retrosternal goitre. Br J Surg 2000;87:519.
  • Majdar S, Weisberg D. Retrosternal goiter. Chest 1995;60:207-12.
  • Hedeyati N, McHenry CR. The Clinical presentation and operative management of nodular and diffuse substernal thyoid disease. Am Surg 2002;68:245-51.
  • Katlic MR, Wang C, Crillo HC. Substernal goiter. Ann Thorac Surg 1985;39:391-9.
  • Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac 1998;14:393-7.
  • Sianesi M, Del Rio P, Arcuri MF, Soliani P, Rusca M. Cervico-mediastian goiter. Chir Ital 2002;54:15-8.
  • Hall TS, Caslowitz P, Popper C, Smith GH. Substernal goiter versus intrathoracic aberrant thyroid: a critical difference. Ann Thorac Surg 1988;46:684-5.
  • Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg 1995;61:826- 31.
  • Wang LS, Shai SE, Fahn HJ, Chan KH, Chen MS, Huang MS. Surgical management of substernal goiter. Scand J Thorac Cardiovasc Surg 1994;28:79-83.
  • Kaya S, Tastepe I, Kaptanoðlu M, Yüksel M, Topcu S, Çetin G. Management of Intrathoracic goitre. Scand J Thorac Cardiovasc Surg 1994;28:85-9.
  • Michel LA, Bradpiece HA. Surgical management of substernal goiter. Br J Surg 1988;75:565-9.
  • Abboud B, Badaoui G, Aoun Z, Tabet G, Jebara VA. Substernal goiter: A rare cause of pulmonary hypertension and heart failure. J Laryngol Otol 2000;114:719-20.
  • Grainger J, Saravanappa N, D’souza A, Wilcock D, Wilson P. The Surgical approach to retrosternal goiters: The role of computerized tomography. Otolaryngol Head Neck Surg 2005;132:849-51.
  • Houck WV, Kaplan AJ, Reed CE, Cole DJ. Intrathoracic aberant thyroid: Identification critical for appropriate operative approach. Am Surg 1998;64:360-362.
  • Andrade MA. A reviev of 128 cases of posterior mediastinal goiter. World J Surg 1977;1:789-97.
  • Marc E. Management of patients with substernal goiters. Surg Clin North Am 1995;75:377-94.
  • Monchik JM, Materazzi G. The necessity for a thoracic approach in thyroid surgery. Arch Surg 2000;135:467- 72.
  • Newman E, Shaha AR. Substernal goiter. J Surg Oncol 1995;60:207-212.

Year 2009, Volume 16, Issue 1, 1 - 5, 30.03.2009

Abstract

References

  • Ýrfanoðlu ME, Abcý Ý, Hatipoðlu AR. Substernal guatrda cerrahi tedavi. Çaðdaþ Cerrahi Dergisi 2003;17:35-8.
  • Maruotti RA, Zannini P, Viani MP, Voci C, Pezzuoli G. Surgical treatment of substernal goiter. Int Surg 1991;76:12-7.
  • Erbil Y, Bozbora A, Barbaros U, Özarmaðan S, Azezli A, Molvalýlar S. Surgical management of substernal goiters: Clinical experience of 170 cases. Surg Today 2004;34:732-6.
  • Retrosternal goiters: safety of surgical treatment. Int Surg. 2003;88:205-10.
  • Armour RH. Retrosternal goitre. Br J Surg 2000;87:519.
  • Majdar S, Weisberg D. Retrosternal goiter. Chest 1995;60:207-12.
  • Hedeyati N, McHenry CR. The Clinical presentation and operative management of nodular and diffuse substernal thyoid disease. Am Surg 2002;68:245-51.
  • Katlic MR, Wang C, Crillo HC. Substernal goiter. Ann Thorac Surg 1985;39:391-9.
  • Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac 1998;14:393-7.
  • Sianesi M, Del Rio P, Arcuri MF, Soliani P, Rusca M. Cervico-mediastian goiter. Chir Ital 2002;54:15-8.
  • Hall TS, Caslowitz P, Popper C, Smith GH. Substernal goiter versus intrathoracic aberrant thyroid: a critical difference. Ann Thorac Surg 1988;46:684-5.
  • Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg 1995;61:826- 31.
  • Wang LS, Shai SE, Fahn HJ, Chan KH, Chen MS, Huang MS. Surgical management of substernal goiter. Scand J Thorac Cardiovasc Surg 1994;28:79-83.
  • Kaya S, Tastepe I, Kaptanoðlu M, Yüksel M, Topcu S, Çetin G. Management of Intrathoracic goitre. Scand J Thorac Cardiovasc Surg 1994;28:85-9.
  • Michel LA, Bradpiece HA. Surgical management of substernal goiter. Br J Surg 1988;75:565-9.
  • Abboud B, Badaoui G, Aoun Z, Tabet G, Jebara VA. Substernal goiter: A rare cause of pulmonary hypertension and heart failure. J Laryngol Otol 2000;114:719-20.
  • Grainger J, Saravanappa N, D’souza A, Wilcock D, Wilson P. The Surgical approach to retrosternal goiters: The role of computerized tomography. Otolaryngol Head Neck Surg 2005;132:849-51.
  • Houck WV, Kaplan AJ, Reed CE, Cole DJ. Intrathoracic aberant thyroid: Identification critical for appropriate operative approach. Am Surg 1998;64:360-362.
  • Andrade MA. A reviev of 128 cases of posterior mediastinal goiter. World J Surg 1977;1:789-97.
  • Marc E. Management of patients with substernal goiters. Surg Clin North Am 1995;75:377-94.
  • Monchik JM, Materazzi G. The necessity for a thoracic approach in thyroid surgery. Arch Surg 2000;135:467- 72.
  • Newman E, Shaha AR. Substernal goiter. J Surg Oncol 1995;60:207-212.

Details

Primary Language English
Journal Section Araştırma Makaleleri
Authors

Hasan Türüt This is me


Mehmet Sırmalı This is me


Göktürk Fındık This is me


Suat Gezer This is me


Gürhan Öz This is me


Koray Aydoğdu This is me


İrfan Taştepe This is me


Sadi Kaya This is me


Güven Çetin This is me

Publication Date March 30, 2009
Submission Date June 1, 2009
Acceptance Date
Published in Issue Year 2009, Volume 16, Issue 1

Cite

Vancouver Türüt H. , Sırmalı M. , Fındık G. , Gezer S. , Öz G. , Aydoğdu K. , Taştepe İ. , Kaya S. , Çetin G. Substernal guatrlarda cerrahi. SDÜ Tıp Fakültesi Dergisi. 2009; 16(1): 1-5.

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