原发性甲状旁腺功能亢进症的围手术期处理

Perioperative management of primary hyperparathyroidism

目的 探讨围 手术期处理对治疗原发性甲状旁腺功能亢进症（ｐｒｉｍａｒｙ ｈｙｐｅｒｐａｒａｔｈｙｒｏｉｄｉｓｍ， ＰＨＰＴ）的影 响。方法 对近１０年治疗２６例ＰＨＰＴ的围手术期处理进行回顾性分析 。结果 病人术前血清钙３．３１ ｍｍｏｌ／Ｌ，５例出现高血钙危象（血清 钙３．７～４．５ ｍｍｏｌ／Ｌ）。术后４ ｄ血清钙降低至最低点１．７４ ｍｍｏｌ／Ｌ。血清甲状旁腺激素由术前 １ ０５０．７ ｐｇ／ｍｌ恢复至正常的１７．１２ ｐｇ／ｍｌ。有２例由于未能及时治疗而死亡。全组累积死亡 率为１１．５％ （３／２６例）。分别为心搏骤停和左心功能不全。结论 重 视围手术期的处理是ＰＨＰＴ治疗的重要环节；对高血钙危象的有效治疗必须尽早开始，以挽救 病人生命。

Objective To examined the therapeutic effec ts of perioperative management for primary hyperparathyroidism.Method Retrospective analysis of perioperative management has been performed on 26 patients identified with primary hyperparathyroidism from 1990 to 1999.Result The preoperative serum calcium value averaged 3.31 mmo l/L, and 5 case had hypercalcemia crisis (3.7～4.5 mmol/L). Average postoperati ve serum calcium fell to the lowest level 1.74 mmol/L on postoperative forth day . Average PTH levels also fell from 1050.7 pg/ml to 17.12 pg/ml after surgery. Two patients with hypercalcemia crisis died before surgery. The overall periop erative mortality was 11.5% (3/26 cases). The death were attributed to cardiac arrest and left ventricular dysfunction.Conclusion It is ne cessary to emphasize perioperative management in treatment of primary hyperparat hyroidism, and the immediate treatment must be considered in any patient with li fe-threatening hypercalcemia crisis.