METHOD FOR SURGICAL TREATMENT OF THYROID CANCER WITH METASTASIS IN NECK LYMPH NODES

摘要

FIELD: medicine.;SUBSTANCE: extrafascial removal of thyroid and neck cellular tissue with lymph nodes is performed under endotracheal anesthesia in compliance with a certain intervention phasing. At that, for surgical access a smaller incision of 10-11 cm is applied starting from the point situated at a distance of 4 cm from mastoid extending along the lateral edge of the sternocleidomastoid muscle and spaced 2-3 cm from the sternoclavicular joint, smoothly passing into a horizontal part parallel to the skin folds and terminating at a point located at a distance of 3 cm from the jugular notch, going over the middle line of the neck by 1 cm with subcutaneous muscles separation with a skin-fat flap. Then the sterno-thyroid and sterno-sublingual, sternoclavicular-mastoid and omohyoid muscles are isolated and mobilized. Next, thyreoidectomy is performed using the extrafascial technique while fully removing the thyroid tissue, including the pyramid portion. At this stage, prevention of damage of the upper and recurrent laryngeal nerves is performed using neuromyography, to maintain parathyroid, "stress-test" is applied, which consists in a periodic light tapping of anatomical structures in the operational field by the surgical instrument, where browning or hyperemia with vascular injection identify parathyroid glands difference from fat lobules and lymph nodes, after thyroidectomy, visualization and preservation of parathyroid glands and recurrent laryngeal nerves, central lymphadenectomy is performed. Then the cellular tissue and lymph nodes of neck zones II-V are removed with preservation of great vessels of the neck, brachial plexus, superficial cervical plexus branches, additional and hypoglossal nerves. At the end of the operation sterno-thyroid and sternohyoid muscle are sustured longitudinally to cover the trachea, the latter is separated from the subcutaneous tissue, the neurovascular bundle is closed by sternocleidomastoid muscle medial edge suturing with sterno-thyroid and grudino- hyoid muscles lateral edge, the wound is sutured in layers, an intradermal suture is imposed, skin glue is used for additional mating of the wound edges. To conduct photodynamic visualization, "Alasens®" preparation dissolved in 50 ml of water is administered 2.5 hours before surgery, based on 30 mg/kg of body weight. Then, during surgery, tissues are irradiated using a portable source of polarized blue light "®Biospec" with a wavelength of 435-440 nm, and parathyroid pink fluorescence is observed using glasses with the characteristics of 190-450 nm OD6+451-460 nm OD5+73% VLT.;EFFECT: method allows high efficiency of parathyroid gland differentiation, reduced incidence laryngeal and additional nerve damage, parathyroid glands damage, to improve functional and cosmetic results of surgery.;2 cl, 8 dwg, 1 ex