Substernal guatrlarda cerrahi

Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Substernal guatrlarda cerrahi Hasan Turut*, Mehmet Sirmali**, Gokturk Findik***, Suat Gezer***, Gurhan Oz***, Koray Aydogdu***, Irfan Tastepe***, Sadi Kaya***, Guven Cetin***. Ozet Amac: Substernal guatr nedeniyle cerrahi tedavi uygulanan hastalarin klinik ve cerrahi acidan analizi amaclandi. Gerec ve Yontem: Ocak 1996-Temmuz 2006 tarihleri arasinda Ataturk Gogus Hastaliklari ve Gogus Cerrahisi Egitim ve Arastirma Hastanesi Gogus Cerrahisi Kliniginde substernal guatr tanisi nedeniyle operasyon uygulanan 34 olgu retrospektif olarak incelendi. Olgular, yas, cinsiyet, basvuru nedenleri, bulgular, cerrahi yaklasimlar, postoperatif histopatoloji ve takip yonunden analiz edildi. Bulgular: Toplam 34 olgunun 19.u bayan, 15.i erkek olup ortalama yas 57.5 (dagilim; 25-71) idi. En sik basvuru nedenleri respiratuar sistemle ilgili yakinmalar (nefes darligi ve oksuruk) idi. Olgularin 28.i (%82.3) standart .Collar. insizyonu ile opere edilirken, geri kalan 6 olguda ek cerrahi prosedurlere (parsiyel/komplet medyansternotomi, torakotomi) gerek duyuldu. Postoperatif histopatolojik inceleme sonucu olgularin, 29.unda (%85.2) tani diffuz/noduler kolloidal guatr olarak raporlanirken, 2 (%5.8) olguda malignite tespit edildi. Operasyon sonrasi mortalite gozlenmezken, toplam morbidite orani %17.6 idi. Sonuc: Substernal guatrli hastalarda cerrahi yaklasim onemli bir tedavi secenegidir. Olgularin buyuk bir kisminda servikal yaklasim yeterli olmakla birlikte, endikasyon durumunda eklenecek parsiyel veya komplet medyan sternotomi ile intratorasik yerlesim gosteren anormal tiroid dokusu dusuk morbidite ve mortalite ile rezeke edilebilir. Anahtar kelimeler: Substernal guatr, tiroid, tiroid cerahisi Abstract Surgical treatment of substernal goiters Objective: Our aim was to analyze the clinical and surgical aspects of the patients with substernal goiter.Materials and Methods: A total of 34 patients who underwent surgical treatment with the diagnosis of substernal goiter at Ataturk Chest Diseases and Chest Surgery Center between January 1996 and July 2005 were evaluated retrospectively. The patients were analyzed with respect to age, gender, presenting symptoms,findings, surgical procedures utilized, postoperative histopathology and follow-up. Results: Of the 34 patients, 19 were female and 15 were male with an age average of 57.5 years (range; 25-71). The most common symptom was related with respiratory system (dyspne and cough). A total of 28 patients (82.3%) were managed via standard .Collar. incision whereas the remain was required a total of 6 additional surgical procedures (partial/complete median sternotomy, thoracotomy). Of the 34 patients, 29 (85.2%) were diagnosed as diffuse/nodular colloidal goiter postoperatively; malignancy was detected in 2 (5.8%) of the patients. There was no operative mortality and our morbidity rate was 17.6%. Conclusion: The management of choice in patients with substernal goiter is to be surgical. Although servical incision is adequate in most of the patients, abnormal thyroid tissue can be resected via additional partial or complete mediansternotomy when indicated in patients with intrathoracic localisation with low morbidity and mortality rates. Key words: Substernal goiter, thyroid, thyroid surgery