手术治疗原发性甲亢206例治疗体会

目的:为了进一步明确甲亢手术治疗中并发症产生的原理,找到减少并发症产生的方法。方法:选择2000年1月～2008年11月我院手术治疗的甲亢患者206例,对患者产生的并发症发生率进行统计,甲状腺危象与先兆1例(0.48%),呼吸困难(需气管切开)1例(0.48%),喉返神经损伤1例(0.48%),为术中误扎,发现后立即松解,1个月后恢复。喉上神经损伤2例(0.97),为可逆性,术后7～10天恢复。所有患者术后无抽搐。切口感染2例(0.971%)。并分析产生的原因。结论:甲亢术前要应用抗甲状腺制剂,使甲状腺功能在正常范围,才可进行手术,否则易发生甲状腺危象;另外,手术操作中要减少对气管的牵拉刺激,术前平和患者的心态,减少气管痉挛的发生;手术时切线距离基底部远,被膜留得多可减少甲状旁腺损伤。

Surgical Treatment of 206 Cases of Primary Hyperthyroidism

Objective:To discuss the causes of the complications during surgery treatment of primary hyperthyroidism in order to reduce their incidence.Methods:Clinical data of 206 cases of hyperthyroidism underwent surgical treatment from January 2000 to November 2008 were retrospectively reviewed.Incidence of the chief surgical complications and their associated clinical factors were analyzed.Results:Thyroid crisis happened in 1 case(0.4%),dyspnea needing tracheotomy in 1 case(0.48%),dyspnea needing tracheotomy in 1 case(0.48%),recurrent taryngeal nerve injury in 1 case(0.48 percent) due to mistaking ligation in operation with the resumption a month after the release,reversible taryngeal superior nerve infection in 2 cases(0.971%) with the resumption 7 to 10 days after surgery,and wound infection in 2 cases(0.971%).No patients occurred tetany.Conclusion:The thyroid function should be preoperatively controlled in the normai range,to avoide thyroid crisis after surgery.Weakening the surgical stretch of the trachea,calmming of patient's mild could be helpful to prevent from tracheal spasms.Longer distance from the incision to the thyroid bottom,and reserving more the thyroid dorsal capsule could reduce the possibility of parathyroid injury.