Substernal guatrlarda cerrahi

Yıl 2009, Cilt: 16 Sayı: 1, 1 - 5, 30.03.2009

Hasan Türüt Mehmet Sırmalı Göktürk Fındık Suat Gezer Gürhan Öz Koray Aydoğdu İrfan Taştepe Sadi Kaya Güven Çetin

Öz

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

Anahtar Kelimeler

Substernal guatr, tiroid, tiroid cerahisi

Kaynakça

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