Estudio comparativo de la morbimortalidad postquirúrgica en las técnicas de tiroidectomía utilizadas en pacientes con cáncer de tiroides, Hospital Regional del IESS Dr.Teodoro Maldonado Carbo 2008-2010
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2014
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El cáncer de tiroides es una enfermedad que se presenta con más frecuencia en mujeres, y siendo una patología tumoral su tratamiento definitivo es quirúrgico. Es indudable que el tratamiento quirúrgico es uno de los pilares del tratamiento, no obstante su utilidad se ve afectada por varias complicaciones tales como lesión del nervio laríngeo recurrente, hipocalcemia transitoria, hemorragia, el efecto de la masa tumoral sobre otros órganos del cuello por ejemplo tráquea, esófago, opérculo del tórax los cuales influyen directamente en la calidad de vida del paciente. El objetivo de este trabajo es comparar la morbilidad y mortalidad producida por la tiroidectomía total sin vaciamiento ganglionar frente a la tiroidectomía total con vaciamiento ganglionar utilizadas en pacientes con cáncer de tiroides y determinar el procedimiento más idóneo, de manera que se pueda incrementar la efectividad de este valioso recurso quirúrgico. Se diseñó para este fin un estudio de metodología tipo descriptiva, de diseño no experimental, longitudinal, retrospectivo en el período de junio del 2008 hasta mayo del 2010. Se analizó a 100 pacientes del Servicio de Cirugía General, los cuales fueron sometidos a cirugía electiva por cáncer de tiroides. En este estudio se observa que el cáncer de tiroides es más frecuente en mujeres que en hombres con una proporción de 3:1, la edad más frecuente de presentación fue de 49 años en el sexo femenino y de 48 años en el sexo masculino, el tipo histológico más común encontrado mediante estudio de anatomía patológica fue el papilar con 85 casos seguido por el carcinoma folicular con 15 casos, no se encontró en esta investigación carcinoma medular ni anaplásico.Las técnicas quirúrgicas más utilizadas fueron la tiroidectomía total con vaciamiento ganglionar presentando 41 complicaciones postquirúrgicas de las cuales 26 corresponden a disfonías y 13 a hipocalcemias, seguida de la tiroidectomía total sin vaciamiento ganglionar con 12 complicaciones observándose 8 disfonías y 4 hipocalcemias, cuya morbilidad en ambas técnicas quirúrgicas fue de tipo transitorio. No se presentaron en este estudio fallecimientos por el uso de las tiroidectomías mencionadas
The Thyroid´scancer is a disease that presents itself as a tumor whose definitive treatment is surgical. This pathology appears most frequently in women. Despite it is unquestionable that surgery has a key place in the therapeutic treatment for thyroid´s cancer, it´s effectiveness can be affected for several complications such as laryngeal inferior nerve lesion, temporary hypocalcaemia and bleeding, wich influence directly in the quality of life that the patient can have after surgery. The goal of this research is to compare the morbidity and mortality caused by the techniques of thyroidectomy used in patients with thyroid cancer and determine the most appropriate procedure, so it can increase effectiveness of this invaluable surgical resource. To accomplish this purpose a descriptive study was design from June, 2008 to May, 2010. It´s methodology consisted in a non – experimental, longitudinal, retrospective that analyzed a hundred patients of General Surgery Service wich were underwent to elective surgery for thyroid cancer. The findings of this study demonstrate that thyroid cancer is more common in women than men with a ratio of 3 to 1. The most common age of onset is 49 years in females and 48 in males and the most common histologic type found by studying pathology was papillary (85 cases) followed by follicular carcinoma (15 cases), medullar or anaplastic carcinoma was not found in the research. The surgical techniques used were total thyroidectomy with lymph node dissection presenting 41 postoperative complications of which 26 relate to a hypocalcemia dysphonia and 13, followed by total thyroidectomy without lymphadenectomy complications observed with 12 8 dysphonia and 4 hypocalcemia, whose morbidity in both surgical techniques was transitory. No deaths occurred in this study by using mentioned thyroidectomy
The Thyroid´scancer is a disease that presents itself as a tumor whose definitive treatment is surgical. This pathology appears most frequently in women. Despite it is unquestionable that surgery has a key place in the therapeutic treatment for thyroid´s cancer, it´s effectiveness can be affected for several complications such as laryngeal inferior nerve lesion, temporary hypocalcaemia and bleeding, wich influence directly in the quality of life that the patient can have after surgery. The goal of this research is to compare the morbidity and mortality caused by the techniques of thyroidectomy used in patients with thyroid cancer and determine the most appropriate procedure, so it can increase effectiveness of this invaluable surgical resource. To accomplish this purpose a descriptive study was design from June, 2008 to May, 2010. It´s methodology consisted in a non – experimental, longitudinal, retrospective that analyzed a hundred patients of General Surgery Service wich were underwent to elective surgery for thyroid cancer. The findings of this study demonstrate that thyroid cancer is more common in women than men with a ratio of 3 to 1. The most common age of onset is 49 years in females and 48 in males and the most common histologic type found by studying pathology was papillary (85 cases) followed by follicular carcinoma (15 cases), medullar or anaplastic carcinoma was not found in the research. The surgical techniques used were total thyroidectomy with lymph node dissection presenting 41 postoperative complications of which 26 relate to a hypocalcemia dysphonia and 13, followed by total thyroidectomy without lymphadenectomy complications observed with 12 8 dysphonia and 4 hypocalcemia, whose morbidity in both surgical techniques was transitory. No deaths occurred in this study by using mentioned thyroidectomy
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Neoplasias de la tiroides, Indicadores de la morbimortalidad, Período posoperatorio, Tiroidectomía, Estudios retrospectivos, Epidemiología descriptiva, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Procedimientos quirúrgicos operativos, Estudio comparativo