甲状腺机能亢进症外科手术治疗后主要并发症

1 postoperative respiratory difficulties and asphyxia: This is the most dangerous complication after operation, occurred at 48 hours after operation. The common causes of inner pressure forced the trachea incision. When is the main operation uncovered hemostasis, or because of vascular ligature slippage caused. The edema of larynx. Mainly due to the operation of trauma or injury caused by tracheal intubation. The postoperative tracheal collapse. Tracheal wall long-term compression, softens, postoperative loss caused by surrounding tissue support. Clinical manifestations of progressive dyspnea, cyanosis, upset that asphyxia. As a result of hemorrhage caused by swelling of the neck, and the drainage mouth, oozy blood etc.. If that happens, immediately at the bedside removal of suture line, open wound, and hematoma removal; if still no improvement, should do immediately tracheotomy, to the patient's condition improves after operation room for further examination, and treatment.

2 recurrent laryngeal nerve injury: is the main direct damage caused by operation, such as cutting, sewing, and clamp or pull over; a few are due to hematoma compression or distraction caused by scar tissue. The former during the immediate symptoms, the latter in operation for several days after onset of symptoms. As to completely cut off or suture recurrent laryngeal nerve, injury is permanent, and clamps, pull or hematoma caused by compression of the damage was temporary, acupuncture, physical therapy, can be in commonly 3 ～gradually recovered within 6 months. The left recurrent laryngeal nerve injury caused by vocal hoarseness, excessive to the ipsilateral adduction improves, postoperative laryngoscopy still see paretic vocal fold abduction, but the patient is not obviously hoarseness. On both sides of the recurrent laryngeal nerve injury may occur with bilateral vocal fold paralysis caused by, or breathing difficulties, required tracheostomy.

3 superior laryngeal nerve injury : more due to ligation, cut thyroid arteriovenous, left the gland very far, without carefully isolated, together with the surrounding tissue caused by ligation of large beam. If the external branch of the superior laryngeal nerve injury, will make the cricothyroid muscle paralysis caused by vocal tone, relaxation, reduce, separation of upwardly extending high the superior pole of thyroid, sometimes injury to the superior laryngeal nerve branch within the laryngeal mucosa, due to sensory loss, patients lose their throat cough reflex will, when eating, especially when drinking water, can cause accidental swallowing and cough. After acupuncture, physiotherapy can recover.

4: operation of parathyroid tetany in error by resection, contusion or its blood supply by Loos, can cause of parathyroid function is insufficient, cause tetany. Symptoms in 1～ 2 days after operation. Light are only face or limbs tonic or numbness, often associated with heart area before stress; heavy occurrence of facial and sibling tetany ( with a painful spasms ). Daily attack several times, every time 10 ～20 minutes, or hours, severe cases with laryngeal and phrenic muscle spasm, can cause suffocation. Late secondary cataracts in both eyes. Does not appear in tetany during intermittent, neuromuscular stress increases significantly, if the preauricular percussion of facial nerve, facial muscles that short spasm ( chrostek syndrome), if forced compression in patients with upper arm nerve, that is caused by the hand of tetany ( Trousseau syndrome).

Calcium much lower serum phosphorus increased, while urinary calcium, phosphorus discharge reduction. Treatment: seizures immediately when the intravenous injection of 10% calcium gluconate and calcium chloride 10 ~ 20 ml. Oral administration of calcium gluconate and calcium lactate from 2 to 4 grams, daily 3 ～4 times, plus vitamin D2, daily 50000 ～100000 units, to induce intestinal absorption. The most effective method is the oral administration of two hydrogen tachysterol ( AT10 ) oil, improve the special role of calcium, thereby reducing the nerve, muscle stress. In recent years, the same conductor parathyroid transplantation, also have curative effect, but not lasting. 5 thyroid crisis: causes hitherto not sure. Used to think: thyroid storm is operation when excessive squeeze thyroid tissue, make a large number of thyroid hormone into the crisis is due to the secretion of ACTH deficiency caused by hyperthyroidism, adrenal cortical hormone synthesis, secretion and metabolism acceleration. For a long time, so that the adrenocortical insufficiency, and operation of traumatic stress induced crisis. Also because of inadequate preoperative preparation, hyperthyroidism symptoms fail very good control to. Clinical manifestations than after 12～within 36 hours of the onset of high fever, rapid pulse and weak ( 120 times per minute or more ), patient impatient, delirium, and even coma, and often vomiting and watery diarrhoea. If not active treatment, patients are often rapidly fatal. So the crisis occurs, should prompt salvage therapy.

Measures included treatment of compound iodine solution 3 ~ 5 ml, oral, emergency from 5 to 10 ml of 10% sodium iodide by adding 500 ml 10% glucose solution in the intravenous infusion, to reduce the release of thyroxine. The use of β blockers or sympatholytic, commonly used with propranolol 5 mg, 5% glucose solution 100 ml intravenous drip, or oral administration of 40～ 80 mg, every 6 hours. Reserpine injection 2 mg muscle, every 6 hours. ③hydrocortisone, daily 200 ～400 mg, fractional intravenous infusion. ④used sedative: luminal sodium 100 mg or mixture of half, intramuscular injection, 6 ~ 8 hours. The cooling: general combining hibernation medicine physical cooling, so that the temperature of the patient to remain at around 370C. The infusion of large amounts of glucose liquid water, electrolyte and acid-base balance. The oxygen inhalation, to alleviate the tissue hypoxia. ⑧if failure can be given digitalis preparations, such as pulmonary edema with furosemide. In 6 patients after relapse : a cause of postoperative recurrence of common causes are: without resection of the thyroid isthmus or pyramidal lobe; or excision of the gland is not enough, and too much residual gland, the inferior thyroid artery ligation or not. The recurrence of thyroid operation again often bring difficult to estimate the difficulty, but also easy to damage of recurrent laryngeal nerve and parathyroid. Therefore, the recurrence of hyperthyroidism, generally in non operation therapy.

7: as a result of hypothyroidism caused by excessive gland resection. Performance of different degree of viscous edema: skin and subcutaneous tissue edema, especially in the face, leaving no dents, dry skin, hair scattered, patients often feel tired, is indifferent, intelligence is slow, slow, loss of libido. In addition, the pulse rate is slow, the temperature low basal metabolic rate decreased. Treatment: long-term administration of thyroid stem agent or thyroxine, generally has a good effect on.