并发呼吸道梗阻的甲状腺自发性出血的临床诊疗(附1例报道)

Clinical diagnosis and treatment of thyroid spontaneous hemorrhage complicated with respiratory tract obstruction: a case report

目的总结并发呼吸道梗阻的甲状腺自发性出血的临床特点,探讨中老年患者该类疾病的临床诊断及治疗选择。方法回顾性分析我院2015年7月收治的1例并发呼吸道梗阻的甲状腺自发性出血的临床资料,并1985年至今国内文献报道的类似病例24例。本研究共纳入患者25例,男性4例,女性21例,年龄24-84岁,颈部包块病史、且术后病理为腺瘤或结节性甲状腺肿20例,否认颈部包块、但术后病理为结节性甲状腺肿1例,无颈部包块病史4例。病程进展时间数十分钟至数十小时。结果插管困难或不能18例,急诊手术治疗23例,其中先行瘤体穿刺、局麻颈前切开减压或气管切开再行全麻手术17例,直接插管全麻手术6例;保守治疗2例。治疗后所有患者均症状缓解,顺利出院。结论并发呼吸道梗阻的甲状腺自发性出血,病程进展迅速,病情风险极大,手术治疗缓解呼吸梗阻为关键,同时清除血肿及切除病灶为主要治疗方案,保守治疗可根据病情选择。

Objective To summarize the clinical characteristics of the patients with thyroid spontaneous hemorrhage complicated with respiratory tract obstruction and explore the clinical diagnosis and treatment options of this disease in middle-aged and elderly patients.Methods The clinical data of one case of thyroid spontaneous hemorrhage complicated with respiratory tract obstruction admitted by our hospital in July 2015 were retrospectively analyzed,and 24 cases of similar cases have been reported in domestic literature since 1985.In this study,a total of 25 patients,including 4 males and 21 females,aged 24-84 years.20 patients had a history of neck mass and postoperative pathology was adenoma or nodular goiter.The cervical mass was denied,but the postoperative pathology was nodular goiter in 1 case.There was no history of neck mass in 4 cases.The course of the disease progresses from dozens of minutes to dozens of hours.Results There were 18 cases with difficulty or failure in intubation.23 cases were treated in emergency surgery,including 17 cases with prior tumor puncture,anterior cervical decompression or tracheotomy,and 6 cases with direct intubation.Two cases were treated conservatively.After treatment,all patients showed relief and smooth discharge.Conclusion Thyroid spontaneous bleeding complicated with respiratory obstruction is progressing rapidly and the risk of this disease is deadly.It is the key to relieve the respiratory obstruction by surgical treatment.Meanwhile,hematoma removal and resection are the main treatment options.Conservative treatment can be selected according to the condition.