SURGICAL TREATMENT OF NODULAR AND MULTINODULAR GOITER OF CERVICO-RETROSTERNAL LOCATION

F.MIRSALIMOV, O.M SHAHSUVAROV, F.KH. SAIDOVA, G. MAMMADBEYOV

Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku,AZERBAIJAN

Retrosternal goiter, conditioning heavy clinical symptoms, is of particular surgical interest. The objective of the investigation was the examination of characteristics of cervico-retrosternal location of goiter and its surgical treatment. For the period from 2000 to 2010, we have operated 142 persons at the age of 28-78 years, with the diagnosis of nodular and multinodular goiter of cervico-retrosternal locaion. 31 (21.8%) of them were males and 68 (78.2%) - women. The mean age was 55.1 years and 63.4% of patients were at the age over 51 years. Increased frequency of cervico-retrosternal forms of goiter with age, as well as increase of the retrosternal spread of goiter are connection with the increase in the duration of the disease. The main complaints of patients included shortn breath, choking, coughing, especially at night, hoarseness and aphonia. Compression of blood vessels leads to bending, expansion, and swelling of the cervical vessels, facial edema. Histological examination identified macromicrofollicular adenomatous colloidal goiter in 42.3% of cases, a combination of colloid adenomatous goiter and chronic autoimmune thyroiditis in 21.8%, a combination of colloid adenomatous goiter with thyroid adenoma in 21.8%, various types of adenomas in 9.2%, thyroid carcinoma in 4.9% of cases. Thus, the cervico-retrosternal localization of goiter occurs more frequently in patients at the age over 51 years and among men (35.6%). In connection with this we consider it necessary to conduct active surgical tactics in patients with nodular and multinodular goiter, spreading over the sternum to prevent compression syndrome.

URGENT STRUMECTOMY AT THE PATIENTS SUFFERED FROM GOITER COMPLICATED WITH ACUTE RESPIRATORY FAILURE

F. M. MIRSALIMOV, O.M.SHAKHSUVAROV, F.KH.SAIDOVA, SH.N.BAGIROVA

Scientific Senter of Surgery named after M.A.Topchubashov, Baku, AZERBAIJAN

Separate information on implementation of urgent strumectomy at the patients suffered from goiter complicated with acute respiratory failure arisen as the result of massive hemorrhage in goiter bringing on sharp compression, flexure of trachea in the literature.

Materials and methods. We have observed 15 patients brought to the clinic and suffered from serious acute respiratory failure. The patients were females at the age from 52 to 64, three women out of them were at the age more than 60. The cause of acute respiratory failure was tumor of the thyroid gland in five cases and nodular goiter of the IV-V degree mainly with retrosternal position in seven cases and recurrent goiter of the IV degree in three cases. All patients were in euthyroid condition. It was possible to reveal from anamnesis that the patients from 10 to 35 year suffered from goiter. Arterial hypertension of the first stage was observed at seven patients, of the second stage at two patients and of the third stage at two patients, six patients had been suffering from light and medium-heavy pancreatic diabetes over 6-12 years. When the patients were admitted glottic spasm, hoarse breathing, expressed cyanosis in the different degrees was observed at all 15 patients, ciliary tachiarrythmia was observed at eight out of them. In the first place urgent intubation of trachea is necessary for putting them out of hypoxic condition in acute respiratory failure conditioned by sharp compression of respiratory tracts by goiter. All patients have been operated under intubation narcosis with neuroleptic analgesia, oxygen and nitrous oxide inhalation. The analysis of our observations witnesses that one of the main moments in treatment of these patients is qualified anesthetic supply of the urgent operation. Preoperative preparation that aims putting patients out of the hypoxia condition, sanitization of respiratory tracts, elimination of cardiovascular disorders and so on is very important too. As well, high qualification of the operating surgeon has great importance for warning about serious complications observed at these patients (injury of recurrent nerves, injury of parathyroid glands and etc.). Implementation of tracheostomy by indications at the right moment sometimes appearing as rescue for the patients is very important too. Postoperative supply of the functional condition of the cardiovascular, respiratory system of the organism is a very serious moment. As our experience indicates, provision of the indicated moments will contribute to improvement of the results of the treatment of this difficult contingent of patients.

Date: 2014-12-28; view: 783