Strumektomia, czyli częściowe usunięcie gruczołu tarczowego, jak każda operacja chirurgiczna niesie za sobą ryzyko wystąpienia powikłań. Wśród najczęstszych jest m.in. pojawienie się krwiaka pooperacyjnego, zakażenie rany czy problemy z jej gojeniem. Co zrobić, aby zminimalizować ryzyko ich wystąpienia?
Jakie są najczęstsze powikłania po strumektomii?
Po operacji usunięcia fragmentu tarczycy może również dojść do niedoboru wapnia w organizmie (hipokalcemii), do którego dochodzi najczęściej na skutek uszkodzenia lub usunięcia przytarczyc.
Pacjenci po strumektomii cierpią również na przejściową niedoczynność przytarczyc lub porażenie nerwów krtaniowych (po uszkodzeniu nerwów). Operacja ta niesie również ryzyko uszkodzenia tchawicy lub przełyku, wystąpienia zespołu Hornera lub dysfagii. Pacjenci mogą także skarżyć się na pojawienie się chrypki, zmian w głosie, a także wyciek chłonki.
Podczas strumektomii bądź na krótko po operacji może dojść do powstania tzw. przełomu tarczycowego, który wiąże się z przeprowadzeniem operacji w stanie nadczynności i niedoczynności. Dlatego tak ważne jest to, aby wszelkie operacje tarczycowe były przeprowadzane podczas eutyreozy, czyli unormowanego poziomu hormonów tarczycowych.
Po tego rodzaju operacji może także dojść do uszkodzenia strun głosowych. Najbardziej narażeni na wystąpienie tego powikłania są osoby z przewlekłą chrypą oraz po przebytej operacji w obszarze śródpiersia. Dlatego ta grupa pacjentów powinna być konsultowana z laryngologiem.
Jak uniknąć powikłań po strumektomii?
W porównaniu z tyreoidektomią, podczas której tarczyca usuwana jest w całości, strumektomia polega na usunięciu jedynie fragmentu gruczołu. W celu zminimalizowania ryzyka powikłań, po operacji zakładany jest ssący drenaż Redona. Jego zadaniem jest kontrola ilości i jakości płynów znajdujących się w tkance podskórnej.
Ryzyko wystąpienia powikłań po tego rodzaju operacji ma również związek z odpowiednim przygotowaniem do zabiegu. Dlatego w związku z tym, należy wykonać kompleksową diagnostykę laboratoryjną i obrazową, która polega na wykonaniu USG tarczycy oraz węzłów chłonnych szyjnych.
Jakie badania należy wykonać przed operacją usunięcia fragmentu tarczycy?
Przed strumektomią niezbędne jest wykonanie takich badań jak morfologia krwi, oznaczenie poziomu hormonów tarczycowych (TSH), poziomu przeciwciał (fT3 i fT4), a także poziomu wapnia w surowicy.
Ponadto u pacjentów z podejrzeniem raka rdzeniastego tarczycy niezbędne będzie zbadanie stężenia kalcytoniny oraz CEA (oznaczanie antygenu rakowo-płodowego). Dodatkowo należy wykonać badanie w kierunku mutacji genu RET i współwystępujących endokrynopatii.
Chorzy, u których podejrzewana jest zaawansowana choroba nowotworowa podstawowym badaniem będzie również rezonans magnetyczny, tomografia komputerowa, pozytonowa tomografia emisyjna oraz cienkoigłowa biopsja aspiracyjna.
Źródło: portal.abczdrowie.pl
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