胃十二指肠溃疡穿孔合并甲状腺功能亢进围手术期处理17例分析

Perioperative management of perforated gastroduodenal ulcer accompanied by hyperthyroidism

目的总结胃十二指肠溃疡穿孔合并甲状腺功能亢进(甲亢)的治疗经验。方法回顾性分析2003年1月至2008年12月天津市南开医院外科收治17例胃十二指肠溃疡穿孔合并甲亢病人的临床资料。结果15例术前诊断合并甲亢的病人,围手术期进行了预防甲状腺危象的处理,无一例发作甲状腺危象;2例漏诊甲亢诊断的病人术后均发生了甲状腺危象,其中1例死亡。结论胃十二指肠溃疡穿孔合并甲亢增加了围手术期风险。术前准备充分、术式简单有效、术后预防性治疗可以避免甲状腺危象的发生。

Objective To summarize the therapeutic experience of perforated gastroduodenal ulcer accompanied by hyperthyroidism.Methods The clinical data of 17 cases of perforated gastroduodenal ulcer accompanied by hyperthyroidism admitted from January 2003 to December 2008 at Tianjin Nankai Hospital were analyzed retrospectively. Results Fifteen cases diagnosed as perforation accompanied by hyperthyroidism before operation were treated actively to prevent thyroid crisis during perioperative period,and no one developed it;two cases missed diagnosis and consequently thyroid crisis occurred in both of them,and 1 case died in the end.Conclusion Perforated gastroduodenal ulcer accompanied by hyperthyroidism increases the risk in perioperative peroid.Adequate preoperative preparation, simple and effective surgical procedure and prophylactic treatment after operation can prevent crisis from happening.