急腹症合并甲状腺危象的围手术期处理

目的 探讨急腹症合并甲状腺危象的围手术期处理.方法 回顾性分析11例急腹症合并甲状腺危象病例的临床资料.结果 本组行阑尾切除术5例、十二指肠溃疡穿孔修补术2例、胃大部分切除术2例、胆总管切开取石"T"管引流术及脾切除术各1例.甲状腺危象发生于术后7例、术中2例及术前2例.抢救成功8例,死亡3例,死亡率27.3%,其中1例术前发生甲状腺危象的十二指肠溃疡穿孔因甲状腺危象抢救不充分,在胃大部分切除术后第1天死于心力衰竭;1例术中发生甲状腺危象的小肠穿孔,尽管甲状腺危象抢救成功,但术后11 d死于肠漏、腹腔脓肿及肺部感染诱发的多器官功能障碍综合征;另1例术后发生甲状腺危象的急性穿孔型阑尾炎因甲状腺危象处理不及时,术后第5天死于昏迷、多器官功能障碍综合征.结论 围手术期尽早识别甲状腺危象和适当的治疗是抢救本病成功的关键,其诊断主要靠临床表现及实验室检查综合判定.

Thyroid crisis complicating acute abdomen

Objective To investigate the perioperative management for patients of thyroid crisis complicating acute abdomen.Methods The clinical data of 11 acute abdomen patients combined with hyperthyroidism were analyzed retrospectively.Results In this study,the surgical procedures were appendectomy in 5 patients,perforation repair for duodenal ulcer in 2 patients,distal gastrectomy in 2 patients,choledochotomy in one patient and splenectomy in one patient.Thyroid crisis occurred postoperatively in 7 patients,intraoperatively in 2 patients and preoperatively in 2 patients.Emergency treatment succeeded in 8 patients,and death occurred in 3 patients,with a death rate of 27.3%,including the preoperative thyroid crisis patient complicating duodenal ulcer perforation,who died of heart sufficiency on the first day postoperation.The second patient suffering from intraoperative thyroid crisis during exploration for perforation of the small bowel died of muhiple organ dysfunction syndrome caused by intestinal fistula,intra-abdominal abscess and lung infection,in spite of successful rescue treatment of thyroid crisis.The third patient was of acute appendicitis with perforation who died of coma and multiple organ dysfunction syndrome on the postoperative 5th day because the concomitant thyroid crisis was overlooked.Conclusions The early recognizing thyroid crisis in perioperative surgical abdomen and adequate treatment is the key to rescue succesS,and the diagnosis mainly depends on comprehensive judgment of clinical presentation and laboratory examination.