THYROIDECTOMY

From Big Medical Encyclopedia

THYROIDECTOMY [lat. (glandula) of thyreoidea thyroid gland + Greek ektome excision, removal; synonym extirpation of a thyroid gland] — the operation consisting at a distance a thyroid gland.

The indication for T. malignant tumors of a thyroid gland and nek-ry forms are thyroiditis (see). Most of the Soviet surgeons defines indications to T. depending on a stage of cancer of thyroid gland also resorts to it only at high degree of its zlokachestvennost and bilateral defeat of gland. In case of limited defeat carry out a hemistrumectomy (removal of one share) or a subtotal resection of a thyroid gland. Absolute contraindications to T. is not present; as temporary contraindications serve the accompanying acute diseases or an aggravation chronic.

Special training of patients for T. it is required at the broken function of a thyroid gland (see. Craw diffusion toxic ). Elimination of the phenomena of a thyrotoxicosis anti-thyroid means (see) allows to avoid thyrocardiac crises (see) in the postoperative period. Ensuring mental and physical rest of the patient, a full-fledged diet, sanitation of an oral cavity and nasopharynx are of great importance. To pregnant T. it is better to make in the second trimester of pregnancy.

Anesthesia at T. — inhalation anesthesia (see) and neyroleptanalgeziya (see); sometimes apply a local infiltration anesthesia (see. Anesthesia local ).

There are several options T., but all of them are united in two groups: 1) with bandaging of thyroid arteries on an extent; 2) without bandaging of thyroid arteries.

The simplest technically and giving the smallest number of complications is Nikolaev's method — subfascial T. without bandaging of thyroid arteries and their branches on an extent. The patient is stacked on a back, with the roller under shovels and the thrown-back head. Cross section of skin 8 — 10 cm long is made on skin folds of a neck or parallel to them is 1 — 2 cm higher than some jugular cutting of a breast. Cuts below this level are not justified since give bad cosmetic effect and do not improve access. Large saphenas cross after imposing of clips in order to avoid an air embolism. The skin rag is not otseparovy-vat. Cross both grudinopodjyazychny muscles. Grudinoshchitovidny muscles after a section of a fascia easily move lateralno. Carefully free the site of a trachea below an isthmus of a thyroid gland then the isthmus is crossed. This reception in case of disorder of breath helps to make quickly a puncture of a trachea or tracheotomy (see). It is more convenient to begin allocation of a thyroid gland from a trachea, taking small vessels and gradually releasing its share. Usually in the beginning delete the right share, and then left. The taken small vessels tie up. Muscles take in P-shaped seams, put separate rare stitches on hypodermic cellulose, on skin — Michel's brackets or seams. As a suture material it is more preferable to use silk or capron since the catgut quite often causes formation of inflammatory infiltrates. Skin seams can be removed for the 3rd days. The wound is drained a rubber strip on 1 — the 2nd days.

During operation the most serious complications are an injury of a recurrent guttural nerve, and in the next few hours after operation — bleeding, tpreotoksiche-sky crisis; insufficiency of epithelial bodies comes to light on 2 — the 3rd days.

At unilateral injury of a recurrent guttural nerve and paresis of the corresponding phonatory band the osiplost of a voice, impossibility to clear the throat, quite often poperkhivany is observed at drink. At bilateral damage tracheotomy in connection with an acute disorder of breath can be required. Bleeding after operation leads to hypostasis of a neck owing to formation of a hematoma. In these cases urgent audit of a wound is necessary. At emergence on 2 — the 3rd days after operation of paresthesia, a cold snap of extremities, spontaneous attacks of spasms it is necessary to suspect insufficiency of epithelial bodies (see. Hypoparathyrosis ). If the postoperative current is complicated by thyrocardiac crisis, appoint corticosteroids in high doses, gangliobloka-Torahs, cardiac glycosides, administration of disintoxication solutions. In prevention of complications an important role is played by careful performance of a technique of operation.

In uncomplicated cases allow to rise next day after operation. After T. replacement therapy in order to avoid development is shown hypothyroidism (see). Recently researches and a wedge, tests of the method of transplantation of a cryotinned parenchyma of a thyroid gland offered for treatment of the hypothyroidism including which developed after T are conducted.

See also Thyroid gland, operations .



Bibliography: Breydo I. S. Surgical treatment of diseases of a thyroid gland, L., 1979; Drachinskaya E. S. and Breydo I. S. Surgery of a thyroid gland, JI., 1963; 3 about r and f with to and Page. Endocrine surgery, the lane with bolg., page 95, 141, Sofia, 1977; Nikolaev O. V. Hirurgiya of endocrine system, M., 1951.


E. N. Bazarova.

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