Ultrasonic architectonics of thyroid gland after use of surgical treatment of welding technologies

Abstract

The aim of the work: to study the state of residual tissue of the thyroid gland and the features of vascular perfusion by ultrasound and Doppler characteristics, after surgery with time, when used during surgical intervention of a welding high-frequency coagulator.

Materials and Methods. Operative intervention using the high-frequency coagulator EKhVA-350MS and EKVZ-300 with frequency of 66 kHz and 440 kHz in mono- and bipolar regimens was performed in patients undergoing in-patient treatment at the Kyiv City Center for Endocrine Surgery, which is a structural subdivision of the Kyiv City Clinical Hospital No. 3. In 230 patients studied the possibility of using electrocoagulation or cutting of thyroid tissues during the last 5 years, in all variants of surgical intervention in volume: resection of one, both parts of the thyroid – in 13 (6 %), hemithyroidectomy – in 60 % (26 %) with resection of another part – in 23 (10 %), thyroidectomy – in 125 (54%), cervical thyroidectomy – in 9 (4 %) of patients. 96 patients after operation on a thyroid gland with tissue preservation underwent ultrasound doplerography on day 10, after 1, 6, 12 months. The capabilities of the apparatus allowed to get the image of the left fabric, determine its size, echo structure, the sizes of newly discovered in the thyroid residue inclusions.

Results and Discussion. At day 10 postoperative examinations in all patients showed heterogeneous hypoanechogenic areas without clear boundaries and stable echostructural values. In 15 (15 %) patients, 10 days after surgery, small hematomas (4–8 mm) were visualized in the thyroid residue in the form of hydrophilic areas with clear contours without capsule, in 18 (19 %) – local or drainage hemorrhages of low density with clear irregularities contours with the passing of time, hematomas and hemorrhages resolved, therefore, 6 months after the operation and later there is no visualization of them, but an organization and fibrosis are observed. In 11 (12 %) patients for 6 months of post-surgery observation, 2–3 mm hyperherogenic, heterogeneous inclusion structures, without clear boundaries, with uneven and unclear contours, are formed in 2–3 mm of electrocoagulation. The amount and size of the granule depends on the histological structure of the operative tissue, which, when lymphoid infiltration of the autoimmune genesis, can fill the entire thyroid residue. Additionally, in this background, in the first year of research, in 18 (19 %) patients, small hyperhognogenic nodes that give an audio track (calcine) can be identified. 2–3 years after the operation the preservation of a smaller size granule was established only in 4 patients. In 5-6 months after the operation, 17 (18 %) patients with parenchyma isolated or around hyperherogenic inclusions established small primary cysts – hydrophilic areas with clear contours. Only in 21 (22 %) surveys from the first days, when performing economical resection and operations in the area of the isthmus and the medial edge of both parts, a healthy (unchanged) parenchyma occurs in the absence of lymphoid infiltration of autoimmune genesis. In 52 (54 %) patients for 6 months after surgery, the structure of parenchyma is homogeneous, fine-grit without pathological changes.