SURGICAL TREATMENT OF THYROID DISEASES COMPLICATED BY TRACHEAL COMPRESSION SYNDROME

Abstract

Background. Diseases of the thyroid gland complicated by tracheal compression syndrome are one of the most severe pathologies of thoracic surgery. The only way to save a patient from suffocation is surgical treatment performed immediately or urgently. The aim of the study is to analyze the results of urgent and emergency surgical treatment of thyroid diseases complicated by tracheal compression syndrome.

Materials and methods. The study included 167 patients who were admitted to the clinic of the State Institution “V.T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine” on an emergency basis and operated on for urgent and urgent indications for tracheal compression syndrome. All patients were divided into 2 groups, depending on the timing of emergency surgical interventions: Group I included patients who underwent surgical interventions for urgent indications within the first day. There were 52 of them (31.1%); Group II patients were 115 (68.9%) operated on for urgent indications during the second and third day after admission. Student's test (t) was used to compare mean absolute values. The χ² criterion was used for comparative analysis of relative indicators. Confidence intervals were calculated using Fisher's method.

Results. An analysis of the types, scope and results of emergency and urgent surgical interventions for compression syndrome was carried out. It was found that patients with differentiated forms of thyroid cancer in the group with urgent indications underwent radical operations more often than patients in the group with emergency indications. Under emergency surgical interventions, radical operations were performed in 8 (22.9%) cases. In the group of patients who underwent urgent interventions, this indicator is 2 times higher - 23 (52.3%) patients (p≤0.05). However, early postoperative complications were observed 4 times more often in the group with emergency indications (p≤0.05).

Conclusions. Surgical treatment of patients with severe respiratory disorders in compression syndrome should be aimed primarily at eliminating the cause by removing the thyroid mass as completely as possible. To determine the optimal amount of surgical intervention at the preoperative stage, it is advisable to conduct an immunocytochemical study to determine the degree of proliferation of thyroid tissue. To determine the terms of surgery in patients with severe respiratory disorders due to thyroid diseases, it is necessary to perform spirography, which will allow to objectively assess the possibility of preoperative preparation and improve the results of surgical treatment. Performing urgent interventions increases the possibility of radical surgical interventions and reduces the incidence of postoperative complications from 21.2% to 5.2%.