ФАКТОРЫ РИСКА ИНТРАОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ ПРИ ДОБРОКАЧЕСТВЕННЫХ ЗАБОЛЕВАНИЯХ ЩИТОВИДНОЙ ЖЕЛЕЗЕ И МЕРЫ ИХ ПРЕДОТВРАЩЕНИЯ

Abstract

The work presents an analysis of the results of thyroid surgery in 3758 patients. The majority of interventions were performed within 1975-1985 and amounted to 2863 (76.18%) cases, of which 72 (1.92%) were for giant benign neoplasms. Diagnosis verification was carried out in 2613 (69.53%) patients using scintigraphy, and in 1145 (30.47%) - echography. The median age was 52.7±15.8 years. The distribution by sex is 713 (18.97%) male and 3045 (81.03%) female. Most 2572 (68.44%) surgical interventions were performed under local anesthesia. Damage to the return nerve after surgery occurred in 127 (3.38%) patients, and in giant neoplasms in 31. In 18 (0.48%) patients, clinical manifestations of return nerve injury occurred on the opposite side. Positive dynamics from the treatment complex were observed in 113 (88.97%) patients, at the same time, 14 (11.02%) had persistent damage to the return nerve. In the early postoperative period there were phenomena of hypocalcemia during the first day in 384 (10.22%) patients, by the end of the second day - in 292 (7.77%), by the end of the third day - in 12 (0.33%), of which 248 (6.59%) are elderly. 112 (2.98%) cases involved intraoperative bleeding. The source of hemorrhage in 103 (2.74%) cases was neoplasm capsule vessels. It has been established that the mismatch between the size of surgical access and pathological mass (giant thyrotoxic goiter), disruption of the stages of intervention (except early planned cases), intimate fusion with the capsule, its thin wall, disregard of video monitoring data are risk factors for intraoperative complications in benign thyroid diseases. The use of nonstandard techniques («making Novocain cushion,» change of intervention algorithm) allows to visualize clearly nearby anatomical structures, and therefore, in the future - atraumatic operation.