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18ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH THYROID
NODULES 1 ^ -j Babajanov A.S. , Abdurakhmanov D.Sh. , Yusupalieva D.B. ,
Tilavova Yu.M.4
1Babajanov Akhmadjon Sulatanbaevich - PhD, Associate Professor Abdurakhmanov Diyor Shukurullaevich - Resident magistracy, DEPARTMENT OF SURGICAL DISEASES № 1, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND;
Yusupalieva Dilnora Bakhodir qizi - Student,
FACULTY OF MEDICINE, Tashkent Pediatric Medical Institute, Tashkent; 4Tilavova Yulduz Muhammadshukur qizi - Student, DEPARTMENT OF SURGICAL DISEASES № 1, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the study included 281 patients with thyroid diseases who were hospitalized in the surgery department of SamMI clinic for surgical treatment from 2010 to 2017. Nodular goiter relapse was observed in 9 patients (4.7%) for 2 to 6 years. The outcome of the operation was satisfactory, and in 30% of these patients atypical cells were found in the opposite lobe of the thyroid gland, despite the fact that it looked clinically intact. Based on the study of the long-term results of treatment of patients with nodular goiter, the optimal amount of surgical intervention was determined for various morphological forms of the nodular goiter. Adequate volumes of surgical treatment are hemistrumectomy , extremely subtotal resection of the thyroid gland andthyroidectomy. With adequate thyroid replacement therapy, the number of relapses after surgical interventions drastically decreases. The highest percentage (4.7%) of relapses, regardless of the morphological form of the nodular goiter, was detected during an economical resection and enucleation of the thyroid gland. Keywords: nodular goiter, strumectomy, relapse.
Relevance. Currently, there are conflicting data in the literature about factors affecting the prognosis of treatment of patients with nodular goiter [4, 8]. Thus, some authors claim that the histological changes in the thyroid gland [3, 4, 5, 7, 10] are decisive in the prognosis of the recurrence of a nodular goiter, while others consider the extent of surgical intervention and the adequacy of thyroid to be the main factors.therapy [1, 2, 6, 9, 11]. Therefore, it is of great interest to determine the influence of various factors on the incidence of nodular goiter recurrence based on the analysis of the long-term results of surgical treatment of patients with nodular goiter and the development of an individualized prediction algorithm to identify a possible relapse in the long-term period. It is the long-term results that are an objective criterion of the correct choice of tactics for treating patients with nodular goiter.
Objective: improvement of surgical treatment of patients with nodular goiter.
Materials and methods: The study included 281 patients with thyroid disease who were hospitalized in the surgery department of SamMI clinic for surgical treatment from 2010 to 2017. Among patients there were 253 (90.03%) women and 28 (9.97%) men. The average age of the patients was 29 ± 6 years (from 7 to 68 years). The patients were called in an active way, using letters, and the archive material of the SamMI clinic was also studied . Patients were carefully studied the history of the disease. Particular attention was paid to the duration of the disease, medical treatment with thyroid drugshormones after surgery. Such indicators as the volume of surgery, complications, outcomes, immediate and long-term results of the surgical method for treating diseases of the thyroid gland were studied. All patients underwent general clinical examination, including palpation of the thyroid gland, auscultation of the heart and blood vessels, ultrasound examination (ultrasound) of the thyroid gland and areas of regional lymphatic drainage in real time (initial and at various times after surgery), determination of the level of thyroid stimulating hormone (TSH) (initial and at various times after surgery), the histology of the removed drug was performed
to all patients. The degree of enlargement of the thyroid gland was assessed according to the classification of Nikolaev O.V. Based on ultrasound and palpation of the thyroid gland. 71 (25.3%) patients were diagnosed with nodular goiter II- III degree, in 210 (74.7%) nodular goiter IV - V degree. By pathological form (according to Penchev), diffuse goiter was detected in 44 (15.69%) patients, nodular goiter - in 192 (68.3%), mixed goiter - in 45 (16.01%). The distribution of patients according to the degree of increase and pathological form of thyroid disease is presented in table 1.
Table 1. The nature of the disease and the degree of enlargement of the thyroid gland according to the classification of Nikolaev
O.V.
Degree of increase thyroid gland Nature of the disease II degree III degree IV degree V degree Total
Diffuse toxic goiter - 13 25 6 4 14
Nodular goiter toxic adenoma - four 3 - 7 192
non-toxic goiter one 27 69 one 98
cystic goiter - eight 74 3 85
cr thyroid - one one - 2
Mixed goiter - 17 27 one 4 15
Total one 70 199 eleven 281
On the basis of hormonal blood tests (the content of triiodothyronine, thyroxine, thyroid-stimulating hormone), as well as the clinical picture of the patients, the thyroid status was established. 278 patients underwent surgical treatment, 3 patients were not operated due to a severe physical condition. The timing of surgery depended on the functional state of the thyroid gland. 48 (17.1%) patients underwent surgical treatment after removal of thyrotoxicosis to euthyroidism (34) and hypothyroidism (14) for 2 to 9 months. 230 (81.8%) patients with eu - and hypothyroid status surgery were performed immediately. The volume of
188
surgical intervention depended on the pathological form of the goiter. Total thyroidectomy It was performed in 7 (2.5%) patients with diffuse toxic goiter and a malignant tumor of the left thyroid lobe, respectively, in 5 and 2 patients. Subtotal resection of the thyroid gland was performed in 81 (28.8%) patients with diffuse and mixed goiter. In the majority of patients, the volume of surgical intervention was limited to one lobe of the thyroid gland; they were 190 (67.6%) patients.
The results of research and discussion . The frequency of complications on the thyroid gland during surgery or in the early postoperative period is directly related to the experience of the surgeon, the number of operations performed by him per year. In the late postoperative period, 193 out of 278 patients were followed up, which amounted to 69.4%. The follow-up period for patients after surgery was from 1 to 5 years, which are presented in Table 2.
Table 2. The timing of observation ofpatients after surgery
Terms of observation up to 1 year 3 years 5 years Total
Number of patients 89 68 36 193
After calling the patients, we conducted a complete examination including clinical examination, palpation, thyroid status assessment using TSH, blood thyroid hormones and reflexometry . According to the obtained results, it was revealed that 174 patients (90.2%) were in a state of euthyroidism , mild hypothyroidism was found in 6 (3.1%), moderate hypothyroidism in 8 (4.1%), severe hypothyroidism was found in 5 patients (2.6%) it should be noted that the degree of heavy postoperative hypothyroidism observed in patients to torym carried total thyroidectomy for a malignant tumor of the thyroid gland (2) and diffuse toxic goiter (3) (Table 3).
Table 3. The state of the function of the thyroid gland at the time of examination of patients at various times after the operation on the thyroid gland (according to clinical evidence)
The state of the function of the thyroid gland Euthyroidism Hypothyroidism
Mild degree or Central tyazhe STI Severe
Number - of patients (%) 174 (90.2%) 6 (3.1%) 8 (4.1%) 5 (2.6%)
Summarizing the results of clinical and hormonal studies, the evaluation of the long-term results of surgical treatment of nodular goiter was carried out. If we consider that the development of hypothyroidism after thyroid surgery is the logical and normal outcome of the operation, which is easily compensated by the appointment of thyroid hormones, then according to this, the full recovery of patients after surgical treatment of nodular goiter is observed in 182 (94.3%) patients. Nodular goiter relapse was observed in 9 patients (4.7%) for 2 to 6 years. All patients with recurrent nodular goiter did not follow the recommendations of the endocrinologist carefully and did not take thyroid hormones after surgery. The results of a fine needle aspiration biopsy coincided with the final histological result in all cases. That is, in these patients, the good quality of the removed node (s) was confirmed. The outcome of the operation was satisfactory, and in 30% of these patients atypical cells were found in the opposite lobe of the thyroid gland, despite the fact that it looked clinically intact .
Findings. The frequency of postoperative complications of surgical treatment of thyroid diseases is very low: postoperative bleeding 4.7%, temporary paresis of the recurrent laryngeal nerve 5.8% , persistent paralysis of the recurrent laryngeal nerve 0%, transient hypoparathyroidism 1.15% permanent hypoparathyroidism 0%. Based on the study of long-term results of treatment of patients with a nodular goiter, the optimal amount of surgical intervention in various nodular morphological forms was determined goiter Adequate volumes of surgical treatment
are hemistrumectomy, extremely subtotal resection of the thyroid
gland and thyroidectomy.
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