EMERGENCY CARE FOR PATIENTS WITH RETROSTERNAL GOITER COMPLICATED BY COMPRESSION SYNDROME

Abstract

Introduction. Cervicomediastinal goiter commonly refers to the location of thyroid gland tissue partially or completely below the level of the jugular notch of the sternum. When thyroid
tissue grows in the mediastinum, there is a high probability of compression syndrome development, which can lead to the development of emergency conditions associated with stenosis of the trachea. Aim of the study — analysis of clinical symptomatology and tactics of specialized surgical care in patients with cervicomediastinal goiter complicated by compression syndrome. Materials
and methods. The study was performed on the basis of retrospective analysis of the results of treatment of 32516 patients with various thyroid pathology at the clinical bases of the Department
of Hospital Surgery of St. Petersburg State Pediatric Medical University in 1974–2021. Goiter of cervicomediastinal localization was revealed in 5456 (16,8%) patients. There were 797 (14.6%) men
and 4659 (85.4%). The age ranged from 18 to 86 years (average 61.0±12.8 years). Results. Ninetythree patients with manifestations of compression syndrome were admitted on urgent indications,
which made up 1.7% of all patients with goiter of cervicothoracic localization. Retrosternal goiter had clinical symptomatology determined on the degree of compression of one or another organ. The most frequent (in all patients) and clinically significant symptomatology was dyspnea at the slightest physical load and at rest. The period from the moment of detection of nodular pathology of the thyroid gland until admission to the hospital for emergency indications was from 5 to 40 years, on the average 11,3±5,2 years. All patients underwent chest radiography in 2 projections with neck capture, thyroid ultrasound. Multispiral computed tomography of the chest was performed for topical diagnostics, determination of the degree of compression, clarification of anatomical relationships, search for signs of malignant growth and lymphadenopathy. Intensive therapy was used to stabilize the condition of all emergency patients and perform interventions after preparation, which took from 1 to 3 days. The operation of choice was thyroidectomy performed in 90 (96,8%) through cervical access and in 3 (3,2%) — through combined access with partial sternotomy. Conclusions. Long-term followup of patients with proliferating polynodose goiter of the retrosternal localization leads to a severe tactical situation: surgery becomes necessary for vital indications due to airway compression in the conditions of progressive somatic pathology, which increases the risk of anesthesia and mortality in the postoperative period. Computed tomography with three-dimensional reconstruction is the most informative diagnostic method determining the tactics, terms, access and probable volume of surgery in patients with a retrosternal goiter. The majority of patients with a retrosternal goiter can be operated through the cervical access. A combination of risk factors increases the probability of widening the access: exceeding at least one of the maximum size of goiter in the transverse plane 2/3 of the corresponding size of the upper thoracic aperture, dystopia into the mediastinum, recurrent and malignant nature of the disease.