Operacija tireoidne žlezde sa kratkotrajnim boravkom u bolnici kod starijih bolesnika: da li je bezbedna?
Sažetak
Uvod/Cilj. Incidenca nodularnih bolesti štitaste žlezde značajno raste sa starenjem, kao i incidenca i agresivnost karcinoma štitaste žlezde. Cilj rada bio je da se utvrdi da li je operacija štitaste žlezde bezbedna kod starijih bolesnika u okviru koncepta kratkotrajnog postoperativnog boravka u bolnici. Metode. U studiji retrospektivnog tipa, analizirane su istorije bolesti svih operisanih bolesnika starijih od 65 godina kojimah je urađena totalna tireoidektomija (TT) ili hemitireoidektomija (HT) u periodu od januara 2012. do decembra 2018. godine. U navedenom periodu ukupno je operisano 976 bolesnika zbog bolesti štitaste žlezde, od kojih je 247 gerijatrijskih bolesnika ispunilo kriterijume da budu uključeni u studiju. Bolesnici kod kojih je bila rađena reoperacija štitaste žlezde, kao i bolesnici kod kojih je istovremeno bila urađena tireoidektomija i disekcija limfnih čvorova vrata, bili su isključeni iz studije. Gerijatrijski bolesnici bili su podeljeni u dve grupe – u prvoj grupi bili su bolesnici kod kojih je izvršena HT (33 bolesnika) a u drugoj su bili bolesnici kod kojih je izvršena TT (214 bolesnika). Svaka od ove dve gerijatrijske grupe, HT i TT, imala je po dve uparene kontrolne grupe. Prvu (I) kontrolnu grupu činili su mlađi bolesnici, od 20–44 godina, a drugu (II) kontrolnu grupu činili su bolesnici srednjih godina, od 45–64 godina. Rezultati. Sve tri grupe kod kojih je bila izvršena TT – gerijatrijska grupa i I i II kontrolna grupa, imale su po 214 bolesnika i svaka od tri grupe kod kojih je bila urađena HT imala je po 33 bolesnika. Kod bolesnika iz sve tri grupe kod kojih je bila izvršena HT, prosečan boravak u bolnici bio je 24 časa, dok je u gerijatrijskoj grupi bolesnika kojima je bila urađena TT, 150 (70,1%) od 214 bolesnika provelo 24 sata u bolnici. U gerijatrijskoj populaciji dolazilo je češće do pojave otoka u predelu vrata i povećane drenaže u odnosu na obe kontrolne grupe, pa je samim tim i postojala potreba za dužom hospitalizacijom. Poređenjem godina starosti, pokazano je da ispitanici sa svakom kasnijom godinom intervencije imaju za 22% manje šanse za nastanak komplikacija, kao i da kod benignih bolesti štitaste žlezde postoje manje šanse za nastanak komplikacija u odnosu na maligne bolesti. Zaključak. Prema rezultatima dobijenim u ovoj studiji, TT se može bezbedno sprovesti u okviru koncepta kratkog boravka u bolnici kod bolesnika mlađih od 65 godina, dok se kod starijih bolesnika dani hospitalizacije mogu produžiti zbog češćih hirurških i nehirurških komplikacija. Kod HT, kratkotrajni postoperativni boravak u bolnici je bezbedan za sve starosne grupe.
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