Tiroit cerrahisinde gamma prob kullanımının yeri, alınan sonuçlara göre tedavinin planlanması
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Tarih
2008
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info:eu-repo/semantics/openAccess
Özet
Trakya Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalında Mayıs 2004-Kasım 2006 tarihleri arasında tamamlayıcı tiroidektomi uygulanan 15 diferansiye tiroit karsinomu olan olgu prospektif olarak incelenmiş, gamma prob ile yapılan cerrahi tedavinin sonuçları ele alınmıştır. İlk operasyonlarında totalden daha az tiroidektomi uygulanmış, patoloji raporları DTC gelen hastalara gamma prob destekli tamamlayıcı tiroidektomi uygulanmış, komplikasyon oranları gözlenmiş, gamma probun etkinliği ortaya konulmağa çalışılmıştır. Preoperatif dönemde TSH değeri ortalama 2,28 (SD:2,3) mIU/L olarak tespit edildi. Ameliyat gününden önceki günün akşamında minimum 2 saat açlık periyodundan sonra hastalara oral yolla 0,1 mCi likit I-131 verildi. Tiroit yatağından arka plan değeri üzerinde sinyal alınan tüm alanlar rezeke edildi. Operasyon başlangıcında arka plan ışıma değeri ortalama 6,3 cps (1,2-52,3), tiroit lojundan alınan bazal ışıma değeri ortalama 305,6 cps (26,9-4378,6) iken rezeksiyon sonrası lojdaki ışıma değerleri ortalama 6 cps (1,2-40,5) olarak ölçüldü. Postoperatif TSH kan seviyesi supresyon tedavisine başlanmadan önce ortalama 53,87 (SD:26,83) mIU/L olarak tespit edildi. İkinci operasyon sonrasında 3 hastada (%20) geçici hipoparatiroidi saptanmış, hiçbir hastada kalıcı hipoparatiroidi saptanmamıştır. Hiçbir olguda geçici ya da kalıcı rekürren sinir felci saptanmamıştır. Postoperatif dönemde tüm hastalarda (%100) Tg seviyesi düştü. Gamma prob destekli yaptığımız operasyonlarda komplikasyon oranlarında literatüre göre artış gözlemedik. Gamma prob eşliğinde yapılan tamamlayıcı tiroidektominin komplikasyon oranlarını artırmadığı ve daha etkin bir cerrahi rezeksiyon sağlayarak postoperatif tedavi ve takipleri kolaylaştırdığı, rekürrenslerin önlenmesinde en etkin yöntem olduğu görüşündeyiz. Anahtar kelimeler: Tiroit karsinomu, gamma prob, totale tamamlayıcı tiroidektomi
Fifteen DTC case performed completion thyroidectomy were examined prospectively and surgical results of gamma probe therapy were observed between May 2004 - November 2006 in Trakya University Medical Faculty Department of General Surgery. Patients who had less then total thyroidectomy in their first operations with DTC pathology reports, went through gama probe supported completion thyroidectomy, complication rates were observed, gamma probe efficiency was examined. In preoperative period, mean TSH value was identified as 2.28 mIU/L (SD:2.3). 0.1mCi liquid I-131 given to the patiens after minimun 2 hours of starvation period one day before the day of surgery. All the areas those had a signal over the back ground values were resected out from thyroid channel. While mean background radiation value was 6.3 cps (1.2-52.3) and mean basal radiation value of thyroid lodge was 305.6 cps (26.9-4378.6), after resection mean radiation value of thyroid lodge is measured as 6 cps (1.2-40.5). Post operative TSH blood level before supression therapy is measured as 53.87 (SD:26,83) mIU/L avarage. After completion surgery, in 3 patients (%20) temporary hypoparathyroidism was stated, in none of the patients permanent hypoparathyroidism was found. In none of the cases, temporary or permanent recurrent nerve paralysation was found. In post operative period all patients (100%) Tg levels decreased. In the operations supported by gamma probe we did not observe any increase in complication rates compared to literature. Completion total thyroidectomy with gamma probe does not increase complication rates and makes post operative treatment and follow up easier by more efficient surgical resection, our contemplation; completion thyroidectomy with gamma probe is the most efficient method in avoiding recurrency. Key words: Thyroid carcinoma, gamma probe, completion total thyroidectomy.
Fifteen DTC case performed completion thyroidectomy were examined prospectively and surgical results of gamma probe therapy were observed between May 2004 - November 2006 in Trakya University Medical Faculty Department of General Surgery. Patients who had less then total thyroidectomy in their first operations with DTC pathology reports, went through gama probe supported completion thyroidectomy, complication rates were observed, gamma probe efficiency was examined. In preoperative period, mean TSH value was identified as 2.28 mIU/L (SD:2.3). 0.1mCi liquid I-131 given to the patiens after minimun 2 hours of starvation period one day before the day of surgery. All the areas those had a signal over the back ground values were resected out from thyroid channel. While mean background radiation value was 6.3 cps (1.2-52.3) and mean basal radiation value of thyroid lodge was 305.6 cps (26.9-4378.6), after resection mean radiation value of thyroid lodge is measured as 6 cps (1.2-40.5). Post operative TSH blood level before supression therapy is measured as 53.87 (SD:26,83) mIU/L avarage. After completion surgery, in 3 patients (%20) temporary hypoparathyroidism was stated, in none of the patients permanent hypoparathyroidism was found. In none of the cases, temporary or permanent recurrent nerve paralysation was found. In post operative period all patients (100%) Tg levels decreased. In the operations supported by gamma probe we did not observe any increase in complication rates compared to literature. Completion total thyroidectomy with gamma probe does not increase complication rates and makes post operative treatment and follow up easier by more efficient surgical resection, our contemplation; completion thyroidectomy with gamma probe is the most efficient method in avoiding recurrency. Key words: Thyroid carcinoma, gamma probe, completion total thyroidectomy.
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery, Gama Kameralar, Gamma Cameras, Tiroid Bezi, Thyroid Gland
