伴巨大甲状腺Graves病的围手术期综合治疗

Multi-disciplinary treatment of Graves' disease with huge-size thyroid during perioperative period

目的总结伴巨大甲状腺Graves病(GD)患者的围手术期综合治疗效果。方法回顾性分析北京协和医院于2006年1月至2016年12月期间收治的8例伴巨大甲状腺的GD患者的临床资料。患者术前均行综合措施准备,并接受甲状腺全切除术。总结围手术期经规范抗甲状腺药物治疗、碘准备及动脉栓塞后甲状腺的功能状况,以及术中出血、术后引流和随诊复发情况。结果所有患者经综合措施(复方碘溶液口服3～4周、抗甲状腺药物重叠使用2～4周及术前24 h内行甲状腺主要供血动脉栓塞)准备后效果满意。8例患者的手术过程顺利,手术时间较短(2.5～4.5 h),术中出血较少(4例≤100 mL),术后颈部引流量少。所有病例无严重或永久并发症(如甲状腺功能亢进危象、语音改变及甲状旁腺功能障碍)发生。8例患者门诊随诊18～133个月,无远期并发症发生,无复发病例。结论伴巨大甲状腺GD病的围手术期处理十分重要,多学科综合措施可有效降低出血、甲状腺功能亢进危象等风险,术中精细操作可有效保护局部重要功能。

Objective To explore the effect of multi-disciplinary treatment of the Graves＇ disease（GD） with huge-size thyroid during perioperative period. Methods Retrospectively analyzed the clinical data of 8 GD patients with huge-size thyroid who got treatment in Pekin Union Medical College Hospital during Jan. 2006 to Dec. 2016. All patients underwent comprehensive preparation before operation and underwent total thyroidectomy. To explore the changes of thyroid function and culture after anti-thyroid drug（ATD）/iodine preparation/arterial embolization before operation, and to summarize situation of the bleeding loss intraoperation, neck-drainage, thyroid function, and relapses after operation.Results All cases got a satisfactory operation result after standard ATD, iodine preparation（Lugol＇s solution 10–15 drops for 3–4 weeks, combined with ATDs for 2–3 weeks）, and main arterial embolization of thyroid in 24 h preoperation. They got shorter operative time（2.5–4.5 h）, less bleeding intraoperation（4 cases≤100 mL）, less neckdrainage, and almost normal retention time. No severe or permanent complications, for example thyroid storm,abnormal voice, and hypoparathyroid occurred. They were followed as outpatients for 18–133 months, and were found a perfect long-term effect without complication and relapse. Conclusions Perioperative period management is very important to those GD patients with huge-sized thyroid, and multi-disciplinary treatment can decrease the intraoperation bleeding, as well as occurrence of thyroid storm effectively. In addition, operated subtly during surgery can protect the recurrent laryngeal nerve and parathyroid effectively.