甲状腺机能亢进症的外科手术治疗简介

    Hyperthyroidism surgical operation treatment of hyperthyroidism ( PHT) is a common endocrine disease. Can be divided into primary, secondary hyperthyroidism hyperthyroidism, advanced adenoma, three. Blood thyroxine increased significantly. Primary hyperthyroidism, most considered to be an autoimmune disease, in young women to see.

    甲状腺机能亢进症的外科手术治疗简介,Hyperthyroidism surgical operation therapy.

    The thyroid gland is mostly diffuse symmetrical enlargement, often also showed exophthalmos syndrome. Secondary hyperthyroidism refers to the simple nodular goiter basis, with nodules secrete large quantities of hyperthyroid glands hormone (T3 ), causing the symptoms of thyrotoxicosis. In 1 patients symptom have thin, easy to sweat, eat too much, emotional irritability, insomnia and other symptoms. 2 the thyroid can diffuse swelling and proptosis, or thyroid nodules. Or higher functional adenoma. Diagnosis on the basis of the 1 patients had obvious symptoms and signs.

    2 basal metabolic rate ( B, M, R ) was significantly elevated, pulse 90 / cent above, blood pressure is normal or increased, especially in sbp. 3 blood thyroxine T4, T3 significantly increased. 4 I 131 isotope scanning showed diffuse thyroid enlargement or nodular change or thyroid advanced adenoma. At the same time with 3 hours and 24 hours of iodine absorption rate increased significantly.

    The principle of operation treatment of 1 thyroid major resection : the need to strictly formal premedication. Operation indications are as follows : nodular hyperthyroidism; high functional adenoma; diffuse hyperthyroidism, by the system of drug treatment, no improvement, or after discontinuation of hair; substernal thyroid hyperthyroidism; within 6 months of pregnancy and hyperthyroidism. The following should not operation ( contraindication ); light diffuse hyperthyroidism after drug treatment, depending on the outcome of adolescent hyperthyroidism exophthalmos;; syndrome of severe and symptoms of thyrotoxicosis light; patient heart lung organ function in severe arrhythmia, drugs failed to improve. Evaluation of the efficacy of 1 cure: the symptoms disappear, the wound healed, the patient recovered to normal work. 2: improvement in symptoms and signs disappeared, the wound healed. The patient is still a little sympathetic arousal or neurasthenic symptoms, or have mild hypothyroidism.

    3: because of no residual thyroid tissue slightly more, symptoms not obvious, the basal metabolic rate is still high, or short and thyrotoxic manifestations of relapse. Tips: strict operation indications and contraindications to recurrence rate and complications of operation is reduced to a minimum. The timely operation restore health work and life. ( a ) surgical treatment status: subtotal thyroidectomy was still present in the treatment of hyperthyroidism is a common and effective method. Anti thyroid drugs cannot cure hyperthyroidism, cannot replace the operation. According to statistics, pure with antithyroid drug treatment cases, about 50% cannot return to work, but after operation treated cases, only 5%. Therefore, if the application of antithyroid drug therapy from 4 to 5 months after treatment can be consolidated, should consider the operation treatment.

    The operation treatment, in addition to adolescent patients, mild condition and accompanied by other serious disorders should not be operation, operation therapy can be. For secondary hyperthyroidism and high function adenoma, antithyroid drugs or iodine 131 treatment effect is not very obvious, but also the possibility of malignant transformation, especially in operation, can only be cured. In an attempt to completely cure the cardiac symptoms, then operation approach, is have the order reversed, but lead to deterioration. For pregnant women, whereas hyperthyroidism in pregnancy may cause adverse effects, by abortion, premature birth, fetal death, toxemia of pregnancy; pregnancy may aggravate the hyperthyroidism. Therefore, in the early, medium, namely maternal pregnancy 4 ~ 6 months, still should consider the operation treatment; to late pregnancy, hyperthyroidism and the mutual influence between has been modest, is waiting for delivery after operation treatment.

    ( two) preoperative preparation and its importance: hyperthyroidism patients in basal metabolic rate and high case, operation is very dangerous. Therefore, the full and perfect preoperative preparation and its significance. 1 first to prepare patients to the ideological work, eliminate the patient's worry and fear. Mental tension, restlessness and insomnia person can be given a sedative and hypnotic drug. Heart failure has occurred, should give the digitalis preparations; accompanied by atrial fibrillation, can be given propranolol or quinidine treatment.

    2 preoperative examination: in addition to a comprehensive physical examination, should also include:①determination of basal metabolic rate, T3T4 examination and 131 iodine uptake test. In patients with increased are subject to periodic review. ②laryngoscopy, vocal fold function determination. The electrocardiogram, and detailed examination of the heart there is no expansion, or other cardiac murmur. ④substernal goiter, should do neck radiography, and let the patient simultaneously ingested developer, to determine the degree of compression of the trachea and esophagus. 3 drug preparation: reduced basal metabolic rate is the important part of preoperative preparation. ①if the patient is high basal metabolic rate, available thiouracil drugs ( methyl or propylthiouracil, methimazole etc.). These drugs can prevent iodine machine process, so that the oxidation of iodide with tyrosine binding.

    In addition, its itself also is the thyroid peroxidase substrate of the enzyme, can effectively prevent the thyroid hormone synthesis, and has important effect on thyroid cell immunity, due to propylthiouracil drugs can cause thyroid enlargement and arterial hyperemia, operation is easy to happen when the bleeding, increases the operation difficulty and danger. Therefore, taking drugs to propylthiouracil with iodine. The symptoms of thyrotoxicosis based control, then switched to oral iodine solution ( Lugol solution ), 3 times daily, from 3 begin each day to drop, increased 1, to 16 drops, to maintain the volume of 3 ~ 5 days. Iodine on thyroid function in hypertrophic state during the initial 24 to 48 hours of normal iodine machine link block, block thyroglobulin hydrolysis, thereby inhibiting the release of thyroxine, thyroid follicular cell degeneration causes, revascularization, brittle reduce reduce. Glands resulting in reduced to harden, thus facilitating removal of the thyroid gland operation. ③for routine application of iodine agent or in combination with antithyroid drugs cannot tolerate or do not play a significant role in the case, can use iodine and propranolol combined with preoperative preparation, propranolol dosage dosing every 6 hours for a time, oral, every time 40 ～60 ml. Propranolol a half life of 3 ~ 6 hours.

    Therefore, the last oral propranolol in 12 hours before surgery; preoperative without atropine, lest the heartbeat rate. In subsequent taking propranolol 4～ 7 days. Propranolol is a beta blockers, may choose to block the target tissueβ receptor on catecholamine action, inhibition of adrenergic activity increase, reduce the peripheral tissues to the symptoms of thyrotoxicosis thyroxine effects, improved. Propranolol can inhibit the release of thyroxine. In recent years, some people advocate completely with propranolol for hyperthyroidism preoperative preparation. Advantages are : on the one hand can shorten the time of preoperative preparation, on the other hand, do not affect thyroid function, immediate postoperative can understand thyroid remnant is partially a function of the state. But most researchers think that : the application of propranolol indications should still be restricted to the case, is also on the iodine agent does not play a significant role in the case, and still with iodine agent applied, completely with propranolol applies only to the high function adenoma patients preoperative preparation. ( three) the timing of the operation: the substance prepared from 2 to 3 weeks after.

    Hyperthyroidism symptoms under control ( patient emotional stability, sleep better, weight gain ), pulse rate stable at 90 times per minute, early, late, in pulse rate fluctuations of not more than 10 times / min, basal metabolic rate in + 20% or T3T4 values in the normal range. The shrinkage of the gland harden, vascular murmur is reduced, can carry out operation. Need to explain, " the appropriate operation time " admittedly generally in basal metabolic rate to near normal and not to decide, but also not entirely as a standard, should also refer to general situation, especially the improvement of circulation system. Pulse rate reduction, pulse pressure returned to normal, often is the appropriate operation time important symbol.