Krasnoselsky N. Reconstructive operations in patients with locally expanded thyroid cancer (experimental and clinical study).

Subject of the study: Locally expanded thyroid cancer. Purpose of the study: The improvement of direct and remote results of surgical treatment of the patient with the locally expanded thyroid cancer by differential use of reconstructive and plastic operations with a glance to process expansion and tumor invasion, morphofunctional peculiarities of thyroid gland, adaptive and compensative capacity of the organism, when the radical interventions are made. Methods of research: Clinical, immunological, biochemical and hormonal methods (ultrasound investigation and ultrasound dopplerography, x-rays computer tomography, angiography, direct and indirect laringotracheoscopy, esophagoscopy), morphological (cytological, histological immunomorphological and ultrastructive), statistical methods were used. Practical significance of the obtained results: The effective system of diagnostics and surgical treatment of locally expanded thyroid cancer was created, which contains identical choice of reconstructive and plastic operations depending on estimation of stage of process expansion and tumor invasion of surrounding organs, morphofunctional peculiarities of the gland, adaptive and compensative capacity of organism. This system allows us to operate the patients, which are considered to be inoperable and unresectable earlier. Also it allows to improve direct and remote results of surgical treatment and to improve the quality of life. Scientific novelty: The effective scheme of diagnostics and surgical treatment of patients with locally expanded thyroid cancer is made out in dissertation, which allows improving fundamentally direct and remote results. The model of reconstructive operations depending on operational trauma of neck structures is created and the results of the morphological changes are studied. The diagnostic program is created. This program gives us permission to estimate the stage of process expansion end tumor invasion, to define in surgical tactics and choice of the volume of operational intervention in patients with locally expanded thyroid cancer. The concept of adaptation index is made out. The value of it characterize the depth of adaptive and compensative capacity of organism upset. The peculiarities of kinetic and the character of malignant cells in operational wound and the central lymph in the early postoperative period are studied. Also it is established that usage of cytosorbtion of lymph with the sorbent СКМ-4М promotes the delay of tumor cells and increases probability of their identification. It is revealed that the cryogenic resection of thyroid gland cancer leads to the thrombosis of blood and lymphatic vessels and promotes the reducing of surge of the tumor cells into the blood and lymphatic system. Degree of introduction: The results of study are introduced to practice of surgical detachments of the Institute of General and Urgent Surgery of the AMS of Ukraine, the Institute of Medical Radiology of AMS of Ukraine, Central Clinical Hospital №5 of Kharkov and the regional oncological clinics ofLugansk and Sumi. The main scientific postulates of the dissertation are included into the lecture material and the seminars of the students of the 5 – 6 course on the Hospital Surgery Department of Kharkov State Medical University. Sphere of application: medicine, surgery.