甲状腺相关急诊的诊断和处理

Diagnosis and treatment of thyroid surgical emergency

目的探讨甲状腺外科急诊相关疾病的特征及预后，提高诊断和治疗的水平。方法回顾性分析了北京协和医院2014年一2014年共收治甲状腺外科相关急诊的临床资料24例，分析其处理方法和预后，采用Fisher的精确检验术进行分析。结果根据病情行保守治疗1例，手术治疗23例，介入治疗2例。总体术前诊断率为45．8％。总体围手术期死亡5例（20．8％），总体死亡7例（29．2％）。8例术前诊断或高度怀疑甲状腺淋巴瘤的患者采用口服或静脉糖皮质激素治疗，使围手术期存活率由50％提升至100％。结论甲状腺外科急诊的病因不一，应根据不同诊断合理的选取治疗方式。对术前高度疑似或诊断后的甲状腺淋巴瘤患者，立即给予糖皮质激素可快速、有效减轻气道梗阻并降低病死率，应予以推广。、

Objective To investigate the characteristics of thyroid surgical emergency related disease and prog- nosis, provide the basis to improve treatment. Methods Retrospective analysis of 24 cases of thyroid surgical e- mergency patients in Peking Union Medical College Hospital, Chinese Academy of Medical between 2004 and 2014 who was performed, and the Fisher analytic method was used. Results According to the condition of diseases, con- servative treatment for 1 case, surgical treatment for 23 cases, interventional therapy for 2 cases were performed. The overall preoperative diagnosis rate was 45.8%. The overall perioperative death were 5 cases （20.8%） , total death were 7 cases（29.2% ）. 8 cases preoperative diagnosed or highly suspected thyroid lymphoma patients were received oral or intravenous corticosteroid treatment, with the use of corticosteroids perioperative survival rate in- creased from 50% to 100%. Conclusions （ 1 ） Thyroid surgical emergency with different causes should quickly make a clinical diagnosis based, on the patient＇s history and examination, select rational treatments. （2） Thyroid lymphoma patients that preoperative highly suspected or diagnosed, immediate received glucocorticoid treatment can reduce airway obstruction and decrease mortality, should be promoted.