RESUMEN
Objective: More than 30,000 thyroid surgeries are performed annually in the Russian Federation. The surgeries are relatively safe because of the prevention methods for postoperative complications. Currently, there is no single effective method of postoperative hypoparathyroidism prevention. This complication is frequently reported and may be health and life-threatening. Aim: We aimed to estimate the effectiveness of the intraoperative ICG-angiography and intrathyroid injection of Brilliant Green for the prevention of postoperative hypoparathyroidism. Material and methods: One hundred and forty-three thyroidectomies were performed. Patients were divided into three groups: intraoperative angiography was used in 24 cases; Brilliant Green was injected in 58 cases to identify parathyroid glands; the visual estimation of the parathyroid preservation was used in 61 cases. Calcium level was measured in all patients before and after surgery. Results: Calcium level in the serum before and after surgery was 2.37±0.14 and 2.27±0.17 in Group 1, 2.38±0.16 and 2.21±0.16 in Group 2, and 2.39±0.17 and 2.18±0.19 in Group 3. Postoperative hypocalcemia was more prominent in the group with the visually estimated PTG than in the two other groups. The differences in postoperative calcium levels in Groups 1 and 3 were statistically different. Pre- and postoperative Parathormone levels were 6.2±0.4 in Group 1, 5.6±0.57 in Group 2, and 3.5±0.32 in Group 3. Postoperative levels significantly differed in Groups 1 and 3 (p<0.01) and in Groups 2 and 3 (p<0.05). Conclusions: ICG-angiography and intrathyroid injection of the Brilliant Green are safe methods of identification and sparing of the parathyroid glands. The severity of hypocalcemia and hypoparathormonemia in Group 3 shows the necessity of finding new methods in endocrine surgery to improve patient outcomes.
Asunto(s)
Hipocalcemia , Hipoparatiroidismo , Humanos , Hipocalcemia/etiología , Hipocalcemia/prevención & control , Calcio , Hipoparatiroidismo/etiología , Hipoparatiroidismo/prevención & control , Glándulas Paratiroides/diagnóstico por imagen , Tiroidectomía/efectos adversosRESUMEN
INTRODUCTION: The aim of our study was to investigate the contributions made to thyroid surgery by outstanding Russian surgeons;' (Pirogov N.I., Bujalskiy I.V., Velyaminov N.A., Bobrov A.A., Lezhnev N.F., Fyodorov S.P., Opel V.A. and others) MATERIALS AND METHODS: Research was done on thyroid surgery in Russia in the period from the early 19th century to the early 20th century and the achievements of Russian surgeons were assessed in relation to progress in the field worldwide, including the difficulties that prevented Russian surgeons from gaining extensive attention at an international level and the steps taken by Russia in the 21st century to share expertise in thyroid surgery with other countries. Data was gathered from 178 documents. Books, manuals, and other scientific publications, as well as doctors reports and patient records were analyzed. Research was done on 15 surgical instruments and 10 photographs. RESULTS: The first description of thyroid surgery in Russia dates back to 1804. In 1831 Nikolaiy Ivanovich Pirogov described the anatomy, topography, syntopy and the main principals of thyroid surgery. In 1847 he performed the first "strumectomy" in the world under general anesthesia. For bleeding control he used 30 - 40 ligatures and vascular forceps with locks. The next operation on the thyroid under anesthesia was carried out 13 years later by Eugene S. Cooper (USA). Ilya V. Bujalskiy (Russia), consultant at St.-Petersburg Mariinsky hospital, used an ether narcosis in May, 1847 and chloroform in August 1848 when operating on the thyroid. One other description of the use of chloroform narcosis , by Paul von Sick (Germany) in 1867. In 1886 Nicolay A. Velyaminov performed thyroid resection in the Mariinsky hospital. In 1904 Russian surgeon Nikolai F. Lezhnev reported on 106 thyroid operations performed with visual control of the recurrent laryngeal nerves in Bobrov's clinic in Moscow, where those techniques had been introduced in 1893. He also dealt with the problem of ectopic goiter, and at sessions of the Pirogov Surgical Society gave case presentations of patients with lingual goiter (1908, 1926). Sergey P. Fedorov was well-known in Europe. That is why William Mayo came to observe his operations. He called Fedorov a "master surgeon". CONCLUSION: The contribution of famous Russian surgeons to the field of thyroid surgery is important and should be appreciated at its true value. KEY WORDS: History, Thyroid surgery.