CC BY
1728. Kurbaniyazov Z.B., Saidmuradov K.B., Rakhmanov K.E. Результата xipyprÍ4Horo л^вання хворих з посттравматичними рубцевими стриктурами мапстральних жовчних протошв та бiлiодiгестивних анастомозiв // Клiнiчна анатомiя та оперативна хiрyргiя, 2014. Т. 13. № 4.
29. Nazyrov F.G., Kurbaniyazov Z.B., Davlatov S.S. Modified method of plasmapheresis in the treatment of patients with purulent cholangitis // European science review, 2018. № 7-8. P. 136-141.
30. Uzganboyevich S.S., Qizi Y.D.B., Qizi T.Y.M. Management of the Mirizzi syndrome and the surgical implications of cholecystcholedochal fistula // Вопросы науки и образования, 2019. № 9 (55).
31. Saydullayev Z.Y. et al. Evaluating the effectiveness of minimally invasive surgical treatment of patients with acute destructive cholecystitis // The First European Conference on Biology and Medical Sciences, 2014. С. 101-107.
32. Shamsiyev A., Davlatov S. A differentiated approach to the treatment of patients with acute cholangitis // International Journal of Medical and Health Research, 2017. С. 80-83.
TACTICS OF TREATMENT OF THYROID NODULES BASED ON THE GRADING SCALE
12 3
Babajanov A.S. , Toirov A.S. , Akhmedov A.I.
1Babajanov Ahmadjan Sultanbayevich - Assistant Professor; 2Toirov Abdukhamid Suvonkulovich - Assistant; 3Akhmedov Adkham Ibodullayevich - Assistant, DEPARTMENT OF SURGICAL DISEASES, PEDIATRIC FACULTY, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the study included 453 patients with thyroid diseases who contacted the Department of Surgery at the Medical Association of the city of Samarkand for complex treatment of 2009 to 2019. In 2009-2014 y 281 patients were under observation, of which 268 patients underwent various types of strumectomy and 13 patients received conservative therapy. These patients constituted the comparison group. The 2nd main group included 172 patients in 2015-2019, which took into account the factors influencing the choice of treatment. The scoring of factors influencing the choice of the method of surgical intervention in patients with thyroid nodules allows you to choose the best way and improve the results of treatment.
Keywords: thyroid gland, nodular goiter, strumectomy, conservative therapy, complication.
Relevance. The problem of timely adequate treatment of pathological formations of the thyroid gland, which today occur in 4-10% of the population, still remains relevant [4, 5, 8]. In the literature available to us there are conflicting data on the factors influencing the choice of treatment of patients with goiter. Despite the use of a complex of modern treatment methods, a satisfactory result is not always achieved, which indicates the need to improve the choice of tactics for treating patients with goiter [2]. The problem of treating patients with thyroid nodules is far from completion [1, 2, 6]. The results of surgical treatment of patients with goiter largely depends on the stage, function and form of the thyroid nodules. In this case, the surgeon faces a difficult task in determining the indications for the use of a particular method of treatment, taking into account various factors [3, 7]. As a rule, when choosing one method of surgery or another, the surgeon considers the possibility of postoperative complications and the risk of goiter recurrence. Therefore, it is of great interest to determine the influence of various factors in the treatment of patients with goiter.
Materials and methods: The study included 453 patients with thyroid diseases who contacted the Department of Surgery at the Medical Association of the city of Samarkand for
complex treatment from 2009 to 2019. Among patients there were 351 (77.5%) women and 102 (22.5%) men. The average age of the examined was 35 ± 6 years (from 7 to 72 years).
In 2009-2014 281 (62.0%) patients were observed, of which 268 (95.4%) patients underwent various types of strumectomy and 13 (4.6%) patients received conservative therapy. These patients constituted the comparison group. The 2nd main group included 172 (38.0%) patients in 2015-2019, which took into account factors influencing the choice of treatment. We evaluated these factors that influence the results of treatment on a scale (certificate of state registration of the computer program No. DGU 05147, Agency on Intellectual Property of the Republic of Uzbekistan). In this regard, the patients of the main group were divided into 3 subgroups (table 1).
Table 1. The distribution of the main group ofpatients into subgroups
Gender Group Total
1st 2nd 3rd
Male 1 38 18 57
Female 7 63 45 115
Total 8 101 63 172
Patients of the 1st subgroup with a total score of up to 5 (program for electronic computers No. DGU 05147) (table 2) performed conservative therapy jointly by endocrinologists (table 3). This group consisted of patients who, as a rule, had small nodules (up to 3 cm in diameter) of the thyroid gland without atypical cells during puncture biopsy. In the 2nd subgroup with the number of points from 6 to 9 with nodular formations of one lobe or isthmus of the thyroid gland, hemistrumectomy or resection of the thyroid gland was performed. In the 3rd subgroup, patients with a score of 10 to 12 who had multinodal, diffuse and mixed pathological forms of the thyroid gland underwent subtotal or total thyroidectomy depending on the results of puncture biopsy (table 3).
Table 2. Point system of a choice of a method of treatment ofpathological educations of a thyroid
gland
No Factors affecting the choice of treatment Characteristic factors Points
I 0
The degree of enlargement of the thyroid gland in O. Nikolaev II 1
1 III 2
IV 3
V 4
Pathomorphological form of the Nodular goiter 1
2 thyroid gland according to Diffuse goiter 2
Penchev Mixed goiter 3
3 Localization of the thyroid gland In one beat 0
In both lobes 1
Hyperthyroidism 0
4 Thyroid status of the thyroid gland Hypothyroidism 1
Euthyroidism 2
5 Inflammation of the thyroid gland there is 0
Not 1
6 Concomitant pathology of vital there is 0
organs Not 1
Type of plastic Gender Age years Total
m w. up to 40 from 40 to 60 over 60
Conservative therapy 1 7 6 2 - 8
Hemistrumectomy 26 41 63 3 1 67
Thyroid resection 12 22 11 21 2 34
Subtotal thyroidectomy 18 43 17 43 1 61
Total thyroidectomy - 2 - - 2 2
Total 57 115 97 69 6 172
In the 2nd and 3rd subgroup of patients, the timing of surgical intervention depended on the functional state of the thyroid gland. 28 (17.1%) patients underwent surgical treatment after removal of thyrotoxicosis to euthyroidism (19) and hypothyroidism (9) for 2 to 9 months. 136 (81.8%) patients with eu- and hypothyroid status surgery were performed immediately.
To compare the obtained results, we took 281 patients as a comparison group, who underwent conservative and operative treatment of thyroid nodules without taking into account the scoring. We used the same methods as in the main groups (table 4).
Table 4. The distribution of patients in the comparison group depending on gender, age and type of
treatment
Type of plastic Floor Age years Total
m w. up to 40 from 40 to 60 over 60
Conservative therapy 2 11 9 4 - 13
Hemistrumectomy 25 98 107 16 - 123
Thyroid resection 6 52 39 19 - 58
Subtotal thyroidectomy 10 71 24 54 3 81
Total thyroidectomy 2 4 - 1 5 6
Total 45 236 179 94 8 281
The results of research and discussion. In the early postoperative period, specific complications were noted in 12 (2.8%) patients out of 432 operated on. Moreover, in the comparison group in 9 (3.3%) patients, in the main group in 3 (1.8%) patients. 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. Table 5 presents data on the frequency of early complications of the surgical method for the treatment of thyroid diseases in our clinic.
Table 5. The frequency of early complications of the surgical method of treating diseases of the
thyroid gland
Type of operation
Complications Hemistrumectomy Thyroid resection Subtotal thyroidectomy Total thyroidectomy Total
main gi\ (n = 34) cont. gr. (n = 58) main gr. (n = 61) cont. gr. (n = 81) main gr. (n = 2) cont. gr. (n = 6)
main gr. (n = 67) cont. gr. (n = 123)
Bleeding 1 - - 1 2
Transient paresis of the recurrent 2 1 1 4
laryngeal nerve
Thyrotoxic Crisis - 1 - - - 1 - - 2
Transient 1 1 2 4
hypoparathyroidism
Total 1 3 - 1 2 4 - 4 12
In the late postoperative period, it was possible to trace 298 of 432 operated patients, which was 68.9%. The follow-up period for patients after surgery was from 1 to 5 years. After calling the patients, we conducted a full examination, including clinical examination, palpation, thyroid status assessment using thyroid stimulating hormone, blood thyroid hormones and reflexometry.
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 (table 6).
Table 6. Long-term results of surgical treatment of diseases of the thyroid gland
Outcomes Group of patients
Core group Control group
abs % abs %
Recovery 120 99.2 169 95.5
Recurrent nodular goiter one 0.8 7 3.9
Thyroid cancer (according to final histology) - - one 0.6
Total 121 100 177 100
Recurrent nodular goiter was observed in 8 patients (2.7%) 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 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.
Thus, the scoring of factors influencing the choice of the method of surgical intervention in patients with thyroid nodules allows you to choose the best way and improve the results of treatment.
Conclusions. In patients of the main group, the frequency of postoperative complications of surgical treatment of thyroid diseases is very low (1.8%).
The outcome of surgical treatment of diseases of the thyroid gland is favorable. Postoperative relapse within 6 years was observed in 0.8% and 3.9% of patients in the main and control groups, respectively. For the prevention of postoperative recurrence of nodular goiter and the treatment of postoperative hypothyroidism, replacement therapy with thyroid hormone drugs under the control of an endocrinologist is necessary.
References
1. Abdurakhmanov D.S., Shamsiev J.Z. Modern state of the problem of diagnosis of thyroid nodules (literature review) // European research: innovation in science, education and technology, 2018. Р. 45-49.
2. Davlatov Salim, Hamraeva Dilrabo, Suyarova Zilola. Analysis of the results of surgical treatment of thyroid nodule // International Journal of Advanced Research and Development. Pp. 43-45.
3. Sultanbaevich B.A. et al. Analysis of the results of surgical treatment of patients with thyroid nodules // Вопросы науки и образования, 2019. № 4 (49).
4. Shamsiyev A.M., Khusinova S.A. The Influence of Environmental Factors on Human Health in Uzbekistan // The Socio-Economic Causes and Consequences of Desertification in Central Asia. Springer, Dordrecht, 2008. Р. 249-252.
5. Yusupov S.A. et al. Отдаленные результаты оперативного лечения узловых образований щитовидной железы // Здобутки ктшчно! i експериментально! медицини, 2017. № 1.
6. Zayniev A.F. et al. Choice of tactics of treatment of thyroid nodules based grading program // International scientific review of the problems of natural sciences and medicine, 2019. Р. 73-81.
7. Daminov F.A. i dr. Khirurgicheskaya taktika lecheniya diffuzno-toksicheskogo zoba // Akademicheskiy zhurnal Zapadnoy Sibiri, 2013. T. 9. № 1. S. 21-21.
8. Zayniyev A.F., Yunusov O.T., Suyarova Z.S. Rezul'taty khirurgicheskogo lecheniya bol'nykh uzlovym zobom // Vestnik nauki i obrazovaniya, 2017. T. 1. № 6 (30).
КЛИНИКО-МОРФОЛОГИЧЕСКИЕ АСПЕКТЫ ПРОГНОЗИРОВАНИЯ БИЛАТЕРАЛЬНОГО МЕТАХРОННОГО
РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ 1 2 Юлдошев Ж.А. , Каримова М.Н.
1Юлдошев Жавлон Абдураим угли - ассистент;
2Каримова Мавлуда Негматовна - доцент, кафедра онкологии, Самаркандский государственный медицинский институт, г. Самарканд, Республика Узбекистан
Аннотация: в исследовании было включено 68 пациенток с метахронным РМЖ, получавших лечение в Самаркандском филиале Республиканском онкологическом и радиологическом научно-практическом Центре с 2007 по 2017 г.г. Больше половины пациенток (69%) составили женщины репродуктивного возраста (от 26 до 49 лет). В большинстве случаев как первичный, так и метахронный РМЖ был диагностирован на более ранних стадиях, чем при одностороннем поражении молочной железы Наиболее важными клинико-морфологическими факторами прогноза, влияющими на выживаемость больных метахронным РМЖ, являются срок возникновения второго рака, размер опухоли в молочной железе, гистологические формы опухоли, объем проведенного лечения, степень поражения регионарных лимфатических узлов и возраст больных.
Ключевые слова: метахронный РМЖ, синхронный РМЖ, мультицентрическая форма роста, метастатический рак контралатеральной молочной железы.
Введение. Рак молочной железы (РМЖ) является одним из самых распространенных онкологических заболеваний и в последние годы вышел на первое место среди других злокачественных опухолей у женщин [2]. По данным ВОЗ, ежегодно в мире диагностируется до 1,3 млн новых случаев РМЖ, и более 500 тыс. женщин умирают от РМЖ [1, 4]. В России, так же как и в странах Европы и Америки, отмечается рост заболеваемости РМЖ. Каждый год выявляется более 52 тыс. новых случаев РМЖ, при этом прирост за 5 лет составил 13.4%. В Узбекистане рак молочной железы занимает первое место в структуре заболеваемости женщин 7,5 на 100000 населения (18,42%). В возрастной группе 40-55 лет рак молочной железы -основная причина смертности женского населения.
Многолетнее наблюдение за больными со злокачественными опухолями молочных желез выявило у значительной части из них первично-множественные неоплазии [4]. Первично-множественный рак молочной железы может быть представлен мультицентрической формой роста, а также двухсторонним поражением молочных желез. Последнее подразделяется на две различные по генезу формы рака: первичный
