WAYS TO IMPROVE THE RESULTS OF SURGICAL TREATMENT OF DIFFUSE TOXIC GOITER.

Abstract

Introduction: This article discusses the prevention of intraoperative complications in the surgical treatment of diffuse toxic goiter. The above complications push surgeons to find a more optimal method of surgical treatment.

Aim: Development of new methods to reduce the risk of intraoperative complications in the surgical treatment of patients with diffuse toxic goiter. Materials and methods of research: From 2017 to September 2020, 85 patients with diffuse toxic goiter were operated in the surgical department of the University Hospital NСJSC «Semey Medical University». The age of the patients ranged from 21 to 68 years. The average age of the patients was 36±2. All patients were divided into 2 groups: I - the main group, which included 39 patients operated using the "method for the prevention of postoperative laryngeal paresis after thyroidectomy" and "instrument for the removal of the recurrent laryngeal nerve", as well as using the technique of thyroid embolization and II- control, in which 46 patients underwent traditional surgical intervention without the use of these techniques.

Results: According to the safety drainage, hemorrhagic discharge was noted in all patients after surgery on the same day. In the main group - in the amount of 16.4±7.4 ml, in the control group - 36.1±8.4 ml (p> 0.05). On the 1st day in the main group of patients, the amount of discharge was scarce or zero, drainage was removed. In the control group, this manipulation was most often performed only for 2 days. All patients were examined by an ENT (ears, nose and throat) doctor on the 3rd day to assess the condition of the vocal cords. 2 patients (4.3%) with unilateral transient paresis of the vocal cords were identified in the control group, while no such problems were found in the main group. A complication in 2 patients in the control group was transient unilateral laryngeal paresis. It was completely medically stopped during the next 4-6 months. Hypoparathyroidism in the main group was registered in 1 (2.5%) cases, while in the control group 4 (8.6%) cases of hypoparathyroidism were observed. Postoperative bleeding was noted in 2 (4.3%) cases in the control group, while in the main group this complication was not noted. The duration of inpatient treatment after thyroid surgery using new techniques ranged from 3 to 8 days, averaging 4.2±0.6 days. In the control group, the same indicator ranged from 5 to 10 days (On average - 6.1±0.8 days). There were no fatal outcomes among the patients of both the main and control groups.

Conclusions: The complex use of a method for the prevention of postoperative laryngeal paresis after thyroidectomy, and the use of a tool for the removal of the recurrent laryngeal nerve during surgery, and preoperative X-ray endovascular embolization of the thyroid arteries in patients with DTG (diffuse toxic goiter) can reduce the risk of intraoperative complications and improve immediate and long-term results of surgical treatment. The use of a new method for the prevention of postoperative laryngeal paresis after thyroidectomy and "a tool for the removal of the recurrent laryngeal nerve" as well as endovascular embolization of the thyroid arteries in the surgical treatment of patients with DTG can reduce the duration of surgery by 26%, the volume of intraoperative blood loss - by 52.5%, and also avoid complications such as recurrent nerve injury and bleeding in early postoperative period.