老年甲状腺机能亢进症的外科治疗

Surgical treatment of elderly patlents with hyperthyroidism

目的总结老年甲状腺机能亢进症(甲亢)外科治疗的经验.方法回顾性分析了该院1990年1月～2004年1月162例60岁以上甲亢病人的外科治疗的临床资料.结果经充分的术前准备,行外科治疗162例,其中毒性结节性甲状腺肿89例,原发性甲亢41例,高功能腺肿20例,合并甲状腺癌9例,亚急性甲状腺炎3例.术中气管痉挛6例;术后发生短期手足抽搦7例及呛咳5例,声音嘶哑2例,肺部感染9例,围手术期死亡2例.随访1～3年,出现甲状腺功能低下(甲低)11例,无甲亢复发.结论老年甲亢继发于甲状腺腺瘤或结节性甲状腺肿伴压迫症状者,或近期显像发现冷结节怀疑癌变者,手术治疗是必要的;老年甲亢术后甲低发生率高,原发性甲亢行药物治疗或放射性碘治疗是更好的选择;充分的术前准备,正确的术式选择,妥善的术后处理,是患者顺利渡过围手术期、减少手术并发症的有力保证.

To explore the effects of surgical treatment on the elderly patients with hyperthyroidis. From January 1990 to January 2004,clinically 162 patients older than 60 years with hyperthyroidism were operated, The results of these patients were reviewed. The different etiologies of hyperthyroidism were followed: toxic multinodular goiter (89 cases); Graves′ disease (41 cases); toxic adenoma (20 cases); TSH-secreting pituitary adenoma (9 cases); subacute thyroiditis (3 cases). no postoperative cases were cracked, 3 cases appeared twitch, 2 cases appeared burking and get right a week later. Following Up 1~3 years, hypothyroidism relapsed in 11 cases, no hyperthyroidism relapsed in all cases. [Conclusion] Surgery should be advised in elderly patient with Graves′ disease and a thyroid nodule; primary hyperthyroidism should be treated with anti-thyroid therapy or radio-iodine because of high possibility of hypothyroidism with surgery. Careful preoperative preparations and correctly post-operative management are very important for achieving well therapy effect.