甲状腺功能亢进的临床治疗体会

目的：探讨甲状腺功能亢进症（甲亢）的手术要点,减少并发症,提高治疗水平.方法：总结36例甲亢手术的临床资料并进行回顾性分析.结果：36例治疗效果良好,无手术死亡及甲状腺危象发生.1例术后24h出现体温 39℃,心率125次/min呈甲状腺危象前兆时,给予地塞米松再应用1～2次, 同时口服心得安 20mg后恢复正常.呼吸困难1例（3.13%）,切口出血1例（3.13%）,给予对症处理后症状缓解.声音嘶哑2例 （6.25%）,其中1例 1月后恢复正常,另例3月后嘶哑减轻但不能恢复至正常.全部病例无死亡,康复出院时患者心率均90次以下,基础代谢率均在正常范围有效率100%.随诊甲亢复发3例（9.38%）,甲减2例（6.25%）,给予药物控制,效果良好.结论：充分完善的术前准备是甲亢手术成功的前提,熟练的手术操作、把握手术要点是甲亢手术成功的关键,不断地总结经验、注意个体差异能获得更好的疗效.

Objective： Hyperthyroidism （Graves） of the operation point, reduce complications and improve the treatment level;Methods： 36 patients with hyperthyroidism and surgery were retrospectively analyzed data;Results： 36 patients with good treatment, no mortality and the occurrence of thyroid storm. I case occurred after 24h body temperature 39 ℃, heart rate I25 - / min showed a precursor of thyroid crisis, the administration of dexamethasone and then apply 1 -2 times, and after oral propranolol 20 mg normal. 1 case of dyspnea （3.13%）, wound bleeding and 1 case （3.13%）, symptomatic treatment for symptom relief. Hoarseness in 2 cases （6.25 %）, 1 patient returned to normal after 1 month, another case of hoarseness after 3 months to reduce but not back to normal. All cases with no deaths, heart rate were discharged when the following 90 times, basal metabolic rate in the normal range was 100%. Followed up with hyperthyroidism relapse in 3 cases （9.38%）, hypothyroidism in 2 cases （6.25%）, given to drug control, good effect. Conclusion： The full comprehensive preoperative preparation is the prerequisite for successful operation of hyperthyroidism, skilled operative, grasp the operation point is the key to successful operation of hyperthyroidism, constantly sum up experience, attention to individual differences to better effect.