Surgical treatment of benign nodular goiter; report of 72 patients

Yıl 2009, Cilt: 36 Sayı: 1, 35 - 38, 01.03.2009

Ediz Yorgancılar

Öz

Surgical resection is usually prefered for the treatment of benign nodular goiter. But the extention of thyroidectomy in the surgical management of benign nodular goiter still remains ontroversial. Seventytwo patients underwent thyroid surgery between April 2002- July2007 in Kızıltepe State Hospital Otorhinolaryngology Service. Of the patients 63 were women (%87.5), 9 were man (%12.5). The range of age was between 15-62 years and mean age was 36,5. Thirtynine patients had unilateral total lobectomy+ istmusectomy (%54.2), 11 patients had unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill Procedure) (%15.3), 20 patients had nearly total thyroidectomy (%27.8), 2 patients had total thyroidectomy (% 2.7). Three patients had seroma (%4.1), 2 patients had hemorrhage requiring operative hemostasis (%2.7), 1 patient had suture reaction(%1.3). Patients have not had permanent or temporary nervus laryngeus recurrens injury, hypoparathyroidism and infection. As a result more extent surgical resections must be preferred by the surgeon for the treatment of benign nodular goiter. The preferable surgical treatment of solitary nodules is lobectomy+isthmusectomy. The multinodular goiter must be treated with unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill procedure) when the remnant thyroid tissue is normal; otherwise nearly total or total thyroidectomy is preferable.

Anahtar Kelimeler

Benign nodular goiter; surgical treatment

Benign nodüler guatrda cerrahi yaklasım; 72 olgunun analizi

Öz

Benign nodüler guatrlı hastaların tedavisinde cerrahi rezeksiyon sıklıkla uygulanmaktadır. Ancak benign nodüler guatıra cerrahi yaklasımda tiroidektominin genisligi halen tartısmalıdır. Kızıltepe Devlet Hastanesi Kulak Burun Bogaz Servisi\'nde Nisan 2002-Temmuz 2007 tarihleri arasında toplam 72 hastaya tiroid cerrahisi uygulandı. Hastaların 63\'ü kadın (%87.5), 9\'u erkekti (%12.5). Otuzdokuz hastaya tek taraflı total lobektomi+istmusektomi (%54.2) , 20 hastaya totale yakın tiroidektomi (%27.8),11 hastaya bir taraf total lobektomi+istmusektomi+ karsı tarafa subtotal tiroid lobektomi (Dunhill prosedürü) (%15,3) , iki hastaya total tiroidektomi (% 2.7) yapıldı. Postoperatif 3 hastada seroma ( % 4.1), 2 hastada eksplorasyon gerektirecek postoperatif hematom (%2.7), 1 hastada sütür reaksiyonu (%1.3), saptandı. Hastalarımızda geçici veya kalıcı nervus laringeus rekürren hasarı, hipoparatiroidi ve infeksiyon saptanmadı. Sonuç olarak benign nodüler guatrın cerrahi tedavisinde mümkün oldugunca genis cerrahi yöntemler tercih edilmelidir. Soliter nodüllerde total lobektomi + istmusektomi, multinodüler guatrda kalan doku saglamsa Dunhill prosedürü, saglam degilse totale yakın veya total tiroidektomi tercih edilmelidir.

Anahtar Kelimeler

Benign nodüler guatr, cerrahi yaklaşım

Kaynakça

• Gaitan E, Nelson NC, Poole GV. Endemic goiter and endemic thyroid disorders. World J. Surg.1991;15:205-6
• Çelik O. Kulak Burun Boğaz Hastalıkları ve Baş Boyun Cerrahisi, 1. baskı. İstanbul:Turgut Yayıncılık TAŞ.,2002:760-769
• Erdogan G, Erdogan MF, Delange F, et al. Moderate to severe iodine deficiency in three endemic goiter areas from the Black Sea region and capital of Turkey. Eur J Epidemiol. 2000;16:1131- 1134.
• Hannan AS. The magnificent seven: a history of modern thyrod surgery. Int J Surg 2006;4:187- 191.
• Koyuncu A, Dokmetas HS, Turan M, et al. Comparison of different thyroidectomy techniques for 2003:50.723-727. J
• Alfred A, Simental JR, Myers EN. Thyroidectomy:Technique and applications. Oper Tech Otalaryngol Head Neck Surg 2003;14:63-73.
• Colak T, Akca T, Kanık A et al . Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. S ANZ J Surg 2004;74:974-978.
• Rojmark J, Jarhult J. High long term recurrence rate after subtotal thyroidectomy for nodular goiter. Eur J Surg1995;161:725-727.
• Pappalardo G, Guadalaxara A, Frattaroli FM, et al.Total compared with subtotal thyroidectomy in benign nodular disease:personal series and review of published reports. Eur J Surg 1998;16:501-506.
• Chao TC, Jeng LB,Linen JD et al. Reoperative thyroid surgery. World J Surg1997;21: 644-647
• Ozbas S, Kocak S, Aydıntug S, et al. Comparison of the complications of subtotal , near total and total thyroidectomy in the surgical management of multinodular goitre. Endocrine J 2005;52:199-205.
• Erbil Y, Barbaros U, Salmaslıoglu A et al. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism nodular 2006;391:567-573. in Arch Surg goiter. Langenbecks
• Bron LP, O’Brien CJ. Total thyroidectomy for clinical benign disease of the thyroid gland . British J Surg 2004;91:569-574.
• Snook KL, Stalberg PLH, Sindu SB, et al. Recurrence after total thyroidectomy for benign multinodular goiter. World J Surg 2007;31:593- 598.
• Reeve TS, Delbridge L, Cohen A,et al. Total thyroidectomy: The preferred option for multinodular goiter. Ann surg 1987;206:782-786.
• Chiang F, Wang L, Huang Y, et al. Recurrent laryngeal nevre palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2004;137:342-347
• Liu Q, Djuricin G, Prinz RA. Total thyroidectomy for benign thyroid disease. Surgery 1998;123:2-7.