MODERNIZATION OF SURGICAL TACTICS IN NODULAR GOITER FORMS

Aim. To improve the results of treatment of patients with nodular thyroid neoplasms by means of modernizing surgical tactics. Materials and methods. The study was carried out at Perm Medical Unit № 1 and Perm Regional Oncological Dispensary; it is presented by retrospective analysis of work over the period from 2009 to 2011. During this period, 4360 patients including 44% of repeated ones were consulted annually. Gender composition: 298 (6,8%) men and 4062 (93,2%) women (women/men ratio – 9,6/1). Patients’ age ranged from 15 to 82. Peak of detecting nodular goiter fell to the age group from 41 to 50 years old (36,3%). Duration of disease was from 1 to 40 years. Results. An important aspect is constant dynamic control of patients with nodular neoplasms aimed at dispensary examination of this category of patients including regular examination by surgeon and endocrinologist with the interval from 6 to 12 months. Nine hundred and eighteen (21,1%) patients underwent surgical treatment with subsequent histological investigation. The following operations were performed: subtotal thyroid resection – in 48% of patients, thyroidectomy – 4%, hemithyroidectomy with isthmus resection – 32%, subtotal resection of thyroid lobe – 16%. Conclusion. Complex of treatment and diagnostic measures, modernization of indications to surgical treatment permitted to reduce the number of thyroid surgeries for nodular lesions to 25% of the examined patients. Rational tactics for treatment of thyroid “nodular neoplasms” is possible when creating endocrine surgery units with obligatory specialized polyclinic reception allowing to choose patients for surgical treatment, follow them up and conduct conservative treatment.