心脏移植受者行甲状腺癌根治术的围手术期管理(附1例报告)

Perioperative management of heart transplant recipients undergoing radical thyroidectomy:a report of 1 case

目的 探讨心脏移植术后甲状腺癌的围手术期管理。方法 回顾分析中国人民解放军总医院第一医学中心2023年2月收治的1例心脏移植术1年后发生甲状腺癌病例诊治经验。结果 经多学科综合治疗协作组(MDT)讨论后行甲状腺癌根治术(甲状腺全切除术+中央区淋巴结清扫)。术后病人生命体征稳定,心肺功能正常,未见明显并发症出现。出院前再次经MDT讨论后决定行促甲状腺激素(TSH)抑制治疗及131I治疗。结论 心脏移植术受者行甲状腺癌手术风险较高,围手术期管理应结合实际医疗水平并充分评估病人个人身体状况,将MDT诊疗模式贯穿治疗过程始终,制定适合病人的个体化治疗方案。

Objective To discuss the perioperative management of thyroid cancer(TC)after heart transplantation.Methods A single TC case diagnosed 1 year after heart transplantation in February 2023 in the First Medical Center,Chinese People's Liberation Army General Hospital was retrospectively analyzed.Results After completing the multidisciplinary team(MDT),the patient was treated with radical resection of thyroid cancer(total thyroidectomy+central lymph node dissection).After the surgery,vital signs showed stable,cardiopulmonary function was normal,and there was no symptoms of hoarseness,difficulty drinking,or hand/mouth numbness.MDT followed up with 131I therapy and thyroid stimulating hormone(TSH)suppression therapy before discharge.Conclusion Heart transplant recipients undergoing TC surgery are at high risk.To ensure the perioperative safety,MDT is important to be applied throughout the process.The treatment plan should be individualizing formulated according to the medical treatment level of own center and the physical condition of the patient.