难控性甲状腺功能亢进症围手术期的处理

目的探讨难控性甲状腺功能亢进症（甲亢）围手术期的处理方法,降低严重并发症的发生。方法回顾分析经药物治疗效果欠佳甚至甲亢难以控制而接受手术治疗的21例甲亢患者的临床资料,分析出手术期的处理措施和经验。结果21例中,13例甲亢症状较重,单一的药物治疗不能控制,需加大药物剂量或多种药物联合应用,不能减量或停用抗甲状腺素药物。待甲状腺功能（甲功）相对正常后加用卢戈液至少2心后实行手术。8例因出现严重药物不良反应而不能坚持服药,在T3,T4水平高于正常的情况下直接加用卢戈液口服,在术前3～5d改为复方碘剂持续静脉滴注。所有患者接受双侧甲状腺大部切除术。手术顺利,无甲亢危象发生,均痊愈出院。3例失访。18例在门诊随诊,随访时间为1～7年,平均3．5年。18例无复发,其中3例术后甲状腺功能偏低,需少量补充甲状腺素片。结论针对不同患者给于个性化准备、术后及时处理甲亢危象前期表现是这类患者取得手术成功的关键。对甲功难于控制到正常者,围手术期给予碘剂持续静脉点滴是一种有效的措施。

The perioperative management of refractory hyperthyroidism

Objective To investigate the perioperative management of refractory hyperthyroidism,and how to decrease severe postoperative complications in these patients.Methods The clinical data of 21 patients whose medical treatment was ineffective or could not control preoperative thyroid heperfunction were analyzed retrospectively,and perioperative management was studied.Results Among the 21 patients,13 patients required large doses of antithyroid drugs and other drugs because the symptoms were serious and they rece...