The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. Material and methods. A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Results. Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory – respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died – one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory – respiratory failure in 18 hours after surgery. Conclusions. 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision
Increasing number of surgical subspecialities causes general surgeons have little experience with more complex procedures as total thyroidectomy. The aim of the study was to present the outcome of total thyroidectomy following its implementation in a district hospital where such procedure has not been performed previously. Material and methods. 293 patients were operated on for goiter between 01.10.2008 and 30.09.2011 in the District Hospital in Proszowice by one contracted endocrine surgeon. Hemithyroidectomy was performed in 75 (23.7%) patients and total thyroidectomy in 191 (76.3%) patients for multinodular goiter and only the latter group was subjected for further analysis. Results. There were no bilateral recurrent laryngeal nerve palsy. A unilateral transient recurrent laryngeal nerve palsy occured in 6 patients (3.1%; 1.5% per risk) and postoperative hypocalcemia in 29 (15.7%) patients. 2 (1%) patients required wound revision due to a postoperative bleeding. Postoperative pathology revealed in 12 (6.2%) patients differentiated thyroid cancer. Conclusions. 1. Total thyroidectomy in a district hospital is still a safe way to operate on thyroid for nonmalignant disorders with low number of complications. 2. Total thyroidectomy is a definite surgical treatment in patients diagnosed by postoperative pathology with differentiated thyroid cancer.
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