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INFLUENCE OF INITIAL AND REPEATER SURGICAL OPERATIONS ON FORECASTS IN PATIENTS WITH THYROID MALIGNIZATION IDENTIFIED AFTER OPERATIONB.A.AGAYEV, R.ZAMANOV
Scientific Center of Surgery after named akad. M,A,Topchubashev, Baku, AZERBAIJAN
Introduction.Initial stages of thyroid gland (G0, G1, Ò0, Ò1) and latent (asymptomatic) cancers are detected in pathomorphologic analysis after operation. As a result there forms a need in serios correction of the treatment strategy and forecasting. Purpose:to organize recurrent and metastatic indicators and specify the optimal volume of repeated surgical operations after various surgical operations in early or latent thyroid carcinomas. Materials and methodsin 297 (,92%)) of 7579 patients diagnoses of which were randomized according tomorpholopic analysis. There was observed “thyroid malignization”: 96 (32,3%- of a respective population) – “J-rin situ, G0”and201 (67,7%) –“latent cancer” identification of which was impossible before the operation. According to the volume and option of initial surgical operation patients were divided into 3 main groups: 1) strumectomies and partial resections; 2) subtotal resections; 3) thyreoidectomies. Repeated operations in all cases were of “thyreoidectomy” nature: 1) without limphodissection; 2) with simple (limited) regionarylimphodissection3) with limphodissectioned enlarged zones. In first 5 postoperative years yearle and in the 10th year recurrent relation between the volume of surgical intervention of metastatic potential and primary and repeated surgical interventiosn were analyzed non-parametrically (P=0,95; ï; ð; c²) correlation-statistically. Results.A number of biochemical, cytogentic, morphologic and immunomorpholoc parameters of thyroid malignation processhas direct influence on recurrent and metastatic indicators. In the period after first simple strumectomy recurrent and metastatic indicators of in GIII stage thyroid carcinomas are statistically high: for reccurrence- c² = 38,7; ð = 0,66; ï<0,05; for metastasis- c² = 24,7; ð = 0,48; ï<0,05. Despite significant negative dynamics in the first 1,0-2,5 years after the initial and subtotal resections in 2,5-6?5 years recurrence and metastatic indicators statisticallygrow. After thyroidectomy performed as initial and repeated operation are related with “lymphodissection” factor; conduct of thyroidectomy operations with limphodissectioned enlarged zones shall be especially noted. Conclusion.In patients with thyroidal malignization detected after the operation influence of the following factors on the forecasting was proved: 1)some laboratory and morphologic parameters of the neoplasm (TSH, TTF-1, galectines, adherines, angiogenesis intensity; type, G), 2) radicalism of initial tumor removal3) level and scope of lymphodissection. INTRAOPERATIVE SCLEROOBLITERATION OF RETICULAR AND VARICOSE VEINS NON-MAIN NATURE B.A. AGAYEV, T.A. SHAMSADINSKAYA Scientific Center of Surgery named after M.A. Topchubashov, Center of angiology, Baku, AZERBAIJAN Chronic venous insufficiency - independent disease, underlying cause of which is cascade of pathological changes at the molecular, cellular and tissue level, caused by venous stasis. CVI can be primary, secondary, as well as congenital and acquired. The aim of our study is to improve results of treatment of CVI of LE with the use of sclerotherapy during surgical interventions. The work included 56 patients (29.6%), which underwent phlebosclerosing treatment at the single step with surgical intervention during complex treatment of chronic venous insufficiency of lower extremities. The presence of long and slightly convoluted inflows with varicose changes without varices were direct indications for intraoperative intervention. At the removal of the great saphenous vein – saphenectomy is of great importance, it was reflected in the preparation of patients and consequently in the following measures: 1) assessment of preoperative condition; 2) marking of vessels with brilliant green; 3) physical examination of the post-surgical condition, and 4) single-step phlebosclerosing treatment. Having thoroughly examined the patients at the first, second, sixth weeks and year we obtained the following results: “Local sclerosis was observed in 56 patients (96.5%), which a year later was reduced to 16 patients (17.2%). Thus, the parameter was observed in 42 patients (72.4%). The indicator “of pains after the introduction” reduced from 58 (100%) to 0, that is, the indicator was removed in 58 patients (100%). The parameter of “pigmentation in the areas of injections” was reduced from 64 patients (69%) to 31 patients (33.3%). Paravasal reactions at the initial stages were detected in 57 (98.2%), and in 7 patients (7.5%) after a year of observations. Consequently, this complication was not detected in 87.9%, i.e, 51 patients. The indicator of “recurrence in the area of hardening” was observed in 10 (17.2%), and after a year of examination it was observed in 9 patients (9.6%). Thus, this parameter was detected in 49 patients (84.4%). Ineffectiveness of the treatment was observed in 1 case (1%). Accordingly, the effect of phlebosclerosing treatment was observed in 57 patients (99%).
PREVENTION OF COMPLICATIONS THAT MAY OCCUR DURING THYROID OPERATIONS R.A.AGAYEV, A.R.AGAYEVA, J.B.MAMMADZADA Scientific Center of Surgery after named akad. M,A,Topchubashev, Baku, AZERBAIJAN
According to information of various authors, there is a growing tendency in the number of thyroid diseases. This is, on the one hand, connected with the increase of various pathologies, and on the other hand application of modern examination methods. According to literature thyroid diseases are encountered in amout 15-20% percent of the population. Despite great success obtained in the surgery of thyroid gland, post operative complications are still encountered. Post-operative hypoparathyreosis of thyroid gland is encountered in 0,1-4,5% of cases after first operation, and in about 11,7% cases after recurrent goiters, injury of return nerves occur in0,3-2,1% ofcases after 1-st operation, and in 9,6% of cases after repeated operations. During monitoing of 204 patients of them 51 (25%) were nodular euthyroidal goiter, 74(36,27%) multinodular euthyroidal goiter,51(25%) diffuse toxic goiter, 5(2,5% recurrentgoiter, 4(1,96%) malignant tumors of the thyroid gland,1(0,49%) toxic adenoma,4 (1,96%) autoimmune thyreoditis, 14(6,86%) mixed toxic goiter, average age constituted 5,9. 26 (12,75%) of patients were men, 178(87,25%) women. After mobilization of gland tissue after the operation subfacila resection ws performed, after the mobilization of the gland tissue integrity of lower and upper lobes of the gland were subjected to subfacial resection, integrity of parathyroid tissues was maintained, arteries were obtained successively, ligated, in the areas of entrance of n.recurrens into gland tissue the operation was performed rapidly and by stages, with the use of microsurgical devices, no electrocoagulation was used. This lead to the formation of adequate atraumatic hemostasis. Piramidal lobe was located at the level of upper laryngx, and there was performed its careful mobilization and removal, it was removed in a form of one block with gland. Operation was completed by the revision of the bed. In post-operative period of the analysed group, complications were observed in 15 patients (5%): in 10 of the transitory hypoparathyreosis, in 5 patients injury of the return nerve were observed, in the result of performed transitory hipoparathyreosis the signs were removed, 2 patients were performed tracheostomy. As a result, the applied surgical method has improved results of the operation. Lead to the reduction of complications, increase of life standards of patients, maintenance of labor activity.
Date: 2014-12-28; view: 765
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