甲状腺手术后呼吸困难、窒息原因及处理

Acute airway complications and respiratory compromise after thyroidectomy:aetiology and management

甲状腺手术后发生呼吸困难的并发症不多见,而一旦发生医患双方对其都不胜其烦。甲状腺术后出血,在颈深筋膜的封闭间隙内形成血肿,压迫气管,引起喉头水肿、呼吸功能障碍;双侧喉返神经损伤后双侧声带内收、声门关闭而通气障碍,导致呼吸困难;长期肿大的甲状腺压迫致气管软化,甲状腺切除后可能发生气管塌陷。甲状腺外科手术治疗效果好而手术并发症少的前提是手术医生熟悉重要的局部解剖,一丝不苟地进行严谨的手术操作。对于有气管狭窄、气管软化的病例应在手术中进行预防性气管切开,可能较甲状腺切除后延迟拔除气管插管更安全。

Thyroidectomy with major respiratory compromise is uncommon complication but troublesome. Bleeding into the deep cervical space after a thyroidectomy resulted in hematoma can cause tracheal compression, laryngeal edema and respiratory compromise. Bilateral recurrent laryngeal nerve injury can result in respiratory obstruction with the vocal cords held together in a midline position. Tracheomalacia and tracheal collapse may result from thyroidectomy for patients with longstanding goiter. To the best outcome with the fewest complications of thyroidectomy, the surgeon should understand the anatomical position of key structures and use meticulous operative technique. For patient with tracheomalacia or tracheal deformity with narrowing, tracheostomy taken intra-operatively is a safe procedure and gives a good alternative to delayed endotracheal extubation in post-thyroidectomy.