Year 2012 Vol. 20 No 4

GENERAL AND SPECIAL SURGERY

V.I. BELOKONEV 1, A.A. STAROSTINA 2, Z.V. KOVALEVA2, E.V. SELEZNEVA2

SUBSTANTIATION OF APPROACHES TO THE SELECTION OF PATIENTS WITH THYROID DISEASES FOR THE OPERATION

State Budgetary Educational Establishment of Higher Professional Education “Samara State Medical University”, Ministry of Health and Social Development of Russia 1,
Municipal Medical Budgetary Establishment “N.I.Pirogov City Clinical Hospital ¹1, Samara 2,
The Russian Federation

Objectives. To substantiate approaches to the selection of patients with thyroid diseases for the operation.
Methods. 204 out of 289 patients (70,58%) with the thyroid diseases were operated on. Patients with a toxic goiter were selected for the operation according to severity of thyrotoxicosis and its complications, terms of non-surgical treatment and its efficiency; patients with nodular euthyroid goiter were selected for the operation according to the sizes of nodules and thyroid gland, development of compression syndrome. Maximum subtotal resection of the thyroid gland leaving a small amount of thyroid tissue up to 3 grams was performed in 62 patients (30,39%). 142 patients (69,61%) were subjected to thyroidectomy, in 37 patients (26,06%) there was no direct visualization of recurrent laryngeal nerves and inferior laryngeal nerves versus 105 (73,94%) patients with visualization.
Results. The temporary phonation changes have been reported in 8 patients (21,62%) who underwent thyroidectomy without visualization of recurrent laryngeal nerves and inferior laryngeal nerves and in 3 patients (2,85%) – with visualization.
At the given volumes of operations there wasn’t any recurrence of thyrotoxicosis in patients with a toxic goiter. However, only /3 of patients did not require a thyroid hormone replacement therapy following this procedure.
Conclusions. The substantiated selection of patients with the thyroid diseases for the operations for thyroid nodules on the basis of the accepted standards has improved the treatment results of this severe pathology. Thyroidectomy is an operation of choice in patients in multinodular goitres. Clinical results indicate to the advantages of thyroidectomy with visualization of recurrent laryngeal nerves and inferior laryngeal nerves while treating patients with thyroid pathology.

Keywords: toxic goiter, nodular euthyroid goiter, subtotal thyroid resection, thyroidectomy
p. 17 – 22 of the original issue
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Address for correspondence:
443099, Rossiyskaya Federatsiya , SAMARAul. Chapaevskaya, d. 89, GBOU VPO «Samarskiy gosudarstvennyiy meditsinskiy universitet»,kafedra hirurgicheskih bolezney ¹2
e-mail: nbelokoneva@yandex.ru,
Belokonev Vladimir Ivanovich
Information about the authors:
Belokonev V.I. Honored Doctor of the Russian Federation, Doctor Of Medical Sciences, Professor, Head of the Surgical Diseases Chair ¹2 of State Budgetary Educational Establishment of Higher Professional Education “Samara State Medical University”
Starostina A.A. Extramural Post-Graduate Student of State Budgetary Educational Establishment of Higher Professional Education “Samara State Medical University”
Kovaleva Z.V. Candidate of Medical Sciences, Surgeon of the Municipal Medical Budgetary Establishment “N.I.Pirogov City Clinical Hospital ¹1 Samara,
Selezneva E.V. Endocrinologist of the MUNICIPAL Medical Budgetary Establishment “N.I.Pirogov City Clinical Hospital ¹1”, Samara.
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