MODERN SURGICAL INTERVENTIONS IN PATIENTS WITH THYROID DISEASES

The study is based on the analysis of the results of surgical treatment of 298 patients with various diseases of the thyroid gland, who were examined and treated in the department of endocrine surgery of the City Clinical Hospital named after S. P. Botkin from 2012 to 2016. 147 (49.3%) patients of the I group were operated on using extrafascial technique with intersection of the prelaryngeal muscles and visualization of the recurrent laryngeal nerve. 151 (51.7%) patients of group II underwent extrafascial surgical interventions from reduced migratory approaches using modern, including original, methodological approaches. For the prevention of paresis of the larynx in the allocation of recurrent laryngeal nerves, microsurgical instruments and magnifying devices were used. For the prevention of postoperative hypoparathyroidism, in addition to carefully accounting for anatomical and topographic-anatomical features, a «stress-test» and a method of double visual-instrumental recording of the parathyroid gland-induced fluorescence were used. In the first group of patients with surgical treatment, the following complications were recorded: in 2 (1.4%) patients developed permanent, in 8 (5.4%) transient postoperative hypoparathyroidism, and in 3 (2.0%) - temporary unilateral laryngeal paresis. The overall incidence of operative complications was 8.8% (13 patients). In the postoperative period, the following complications were recorded in group II: 2 (1.3%) patients developed transient hypocalcemia, and 1 (0.7%) patient had unilateral laryngeal paresis. The overall incidence of operative complications was 1.99% (3 patients). Analysis of the cosmetic result of the intervention, assessed on the POSAS scale, showed that cosmetic effect was better in group II (p << 0.05). Thus, modern surgical interventions in patients with thyroid diseases, including new methodological approaches, have improved the results of surgical treatment with a decrease of the number of complications and achieving a better cosmetic effect of the surgical intervention.

surgery, thyroid gland, parathyroid gland, photodynamic, local spectroscopy, recurrent laryngeal nerve, migratory access