ROLE OF MODERN DIAGNOSTIC METHODS IN DETERMINING OF SURGICAL TACTICS IN PATIENTS WITH RETROSTERNAL GOITER

Abstract

Introduction. Retrosternal goiter is called the location of the thyroid gland partially or completely below the level of the jugular notch of the sternum. Its frequency is in the range 10–15% in the structure of thyroid pathology. The aim of the study is to search for factors that can affect the course and volume of surgical intervention in patients with retrosternal goiter. Material and methods. The study was performed in a clinic of the Center of Endocrine Surgery, where 1156 operations for various thyroid diseases were performed in 2011–2019. Cervicothoracic goiter was detected in 227 (19.6%) patients. Results and discussion. The retrosternal goiter had clinical symptoms depended on the degree of compression of mediastinal and neck organs. Persistent compression contributed to relative compensation and the asymptomatic course in 78 (34.4%) patients. Computed tomography had the leading role in diagnostic. It makes possible to clarify the localization, determine the degree of compression of the neck organs, especially the trachea, and assess the deformation of the mediastinum. The most significant factors for surgical tactics and the likelihood of expanding the volume of the operation were: size of goiter retrosternal part and its relationship with the upper thoracic aperture, localization of the goiter in the anterior or posterior mediastinum, the relations of thyroid tissue with vital organs, large vessels and nerve trunks. Supplementation of cervical access with longitudinal transverse sternotomy was planned in 18 cases, but the real need for it arose only in 2 (0.9%) cases. Conclusion. 1. Computed tomography with three- dimensional reconstruction is the most informative diagnostic method for the choice of surgical tactics in patients with retrosternal goiter. 2. Modern software allows qualitative and quantitative analysis of tomograms with the identification of possible risk factors for changes in the volume of intervention. 3. Most patients with retrosternal goiter can be operated on through cervical access. 4. Quantitative spirography assessment could be used to determine the urgency of the intervention.