甲狀腺/甲狀旁腺術后早期低鈣血癥誘發的清醒狀態下喉痙攣2例報道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

湯敏譽 ¹ ,  梁鵬 ^1,2

1. ;
2. ;

Corresponding?author：

梁鵬, Email: liangpengwch@scu.edu.cn

Keywords：

喉痙攣; 低鈣血癥; 甲狀腺切除術; 甲狀旁腺切除術; 瀕死感

DOI：

10.7507/1007-9424.202110045

Video：

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目的總結甲狀腺/甲狀旁腺術后早期低鈣血癥誘發的清醒狀態下喉痙攣的原因及防治措施。方法對2例甲狀腺/甲狀旁腺術后早期低鈣血癥誘發喉痙攣患者的臨床資料進行回顧性分析。結果 1例甲狀腺右葉乳頭狀癌患者行甲狀腺全切除 + 頸部右側淋巴結清掃 + 右側中央區淋巴結清掃，1例三發性甲狀旁腺功能亢進癥、左下甲狀旁腺增生患者行頸部探查 + 左側甲狀旁腺全切除 + 術中喉返神經探查監測術。2例患者術后早期血清鈣水平較術前迅速下降，患者清醒狀態下出現喉痙攣。2例患者均予快速補充鈣劑后，呼吸困難的臨床癥狀迅速緩解。結論甲狀腺/甲狀旁腺切除術后可出現低鈣血癥，如血清鈣水平迅速下降，甚至在清醒狀態下誘發喉痙攣，及時糾正低鈣血癥后喉痙攣可迅速緩解，此類患者術后需要監測血清鈣水平并預防性補鈣。

Citation： 湯敏譽, 梁鵬. 甲狀腺/甲狀旁腺術后早期低鈣血癥誘發的清醒狀態下喉痙攣2例報道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 943-945. doi: 10.7507/1007-9424.202110045 Copy

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11.	Isk Y, Goktas U, Yuzkat N, et al. Hungry bone syndrome as a cause of recurrent laryngospasm after parathyroidectomy. Eur J Anaesthesiol, 2011, 28(2): 142-143.
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13.	Shane E, Bilezikian JP. Parathyroid carcinoma: a review of 62 patients. Endocr Rev, 1982, 3(2): 218-226.
14.	Ho LY, Wong PN, Sin HK, et al. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol, 2017, 18(1): 12. doi: 10.1186/s12882-016-0421-5.
15.	Tsai WC, Peng YS, Chiu YL, et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol, 2015, 47(7): 1203-1207.
16.	Kirkby-Bott J, Markogiannakis H, Skandarajah A, et al. Preoperative vitamin D deficiency predicts postoperative hypo calcemia after total thyroidectomy. World J Surg, 2011, 35(2): 324-330.
17.	Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab, 2020, 105(6): 1722-1736.
18.	Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol, 2020, 41(2): 102370. doi: 10.1016/j.amjoto.2019.102370.
19.	王玉霞, 于露, 曾慶萃, 等. 骨饑餓綜合征導致低鈣抽搐一例報道并文獻復習. 中國全科醫學, 2019, 22(23): 2889-2892.
20.	Wolak S, Scheunchen M, Holzer K, et al. Impact of preoperative Vitamin D3 administration on postoperative hypocalcaemia in patients undergoing total thyroidectomy (HypoCalViD): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 101. doi: 10.1186/s13063-016-1216-5.
21.	郝智. 甲狀腺癌術后急性喉痙攣1例. 臨床耳鼻咽喉頭頸外科雜志, 2016, 30(6): 503-504.
22.	Arer IM, Kus M, Akkapulu N, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg, 2017, 38: 9-14.
23.	Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(2): 142-146.
24.	Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist, 2013, 18(5): 533-542.

1. Bu?a G, Mucha R, Paliga M, et al. Postoperative acute respiratory failure in patients treated surgically for goiters. Pol Przegl Chir, 2015, 87(7): 331-335.
2. Materazzi G, Ambrosini CE, Fregoli L, et al. Prevention and management of bleeding in thyroid surgery. Gland Surg, 2017, 6(5): 510-515.
3. Pardal-Refoyo JL, Ochoa-Sangrador C. Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis. Acta Otorrinolaringol Esp, 2016, 67(2): 66-74.
4. 孫輝, 劉曉莉, 張大奇, 等. 甲狀腺手術中喉返神經保護及監測的臨床應用. 中國普外基礎與臨床雜志, 2010, 17(8): 768-771.
5. Tang JA, Salapatas AM, Bonzelaar LB, et al. Parathyroidectomy for the treatment of hyperparathyroidism: thirty-day morbidity and mortality. Laryngoscope, 2018, 128(2): 528-533.
6. Witteveen JE, van Thiel S, Romijn JA, et al. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol, 2013, 168(3): R45-R53.
7. Mittendorf EA, Merlino JI, McHenry CR. Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg, 2004, 70(2): 114-119.
8. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ, 2008, 336(7656): 1298-1302.
9. Adler JT, Sippel RS, Schaefer S, et al. Preserving function and quality of life after thyroid and parathyroid surgery. Lancet Oncol, 2008, 9(11): 1069-1075.
10. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid, 2018, 28(7): 830-841.
11. Isk Y, Goktas U, Yuzkat N, et al. Hungry bone syndrome as a cause of recurrent laryngospasm after parathyroidectomy. Eur J Anaesthesiol, 2011, 28(2): 142-143.
12. Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol, 2018, 13(6): 952-961.
13. Shane E, Bilezikian JP. Parathyroid carcinoma: a review of 62 patients. Endocr Rev, 1982, 3(2): 218-226.
14. Ho LY, Wong PN, Sin HK, et al. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol, 2017, 18(1): 12. doi: 10.1186/s12882-016-0421-5.
15. Tsai WC, Peng YS, Chiu YL, et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol, 2015, 47(7): 1203-1207.
16. Kirkby-Bott J, Markogiannakis H, Skandarajah A, et al. Preoperative vitamin D deficiency predicts postoperative hypo calcemia after total thyroidectomy. World J Surg, 2011, 35(2): 324-330.
17. Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab, 2020, 105(6): 1722-1736.
18. Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol, 2020, 41(2): 102370. doi: 10.1016/j.amjoto.2019.102370.
19. 王玉霞, 于露, 曾慶萃, 等. 骨饑餓綜合征導致低鈣抽搐一例報道并文獻復習. 中國全科醫學, 2019, 22(23): 2889-2892.
20. Wolak S, Scheunchen M, Holzer K, et al. Impact of preoperative Vitamin D3 administration on postoperative hypocalcaemia in patients undergoing total thyroidectomy (HypoCalViD): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 101. doi: 10.1186/s13063-016-1216-5.
21. 郝智. 甲狀腺癌術后急性喉痙攣1例. 臨床耳鼻咽喉頭頸外科雜志, 2016, 30(6): 503-504.
22. Arer IM, Kus M, Akkapulu N, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg, 2017, 38: 9-14.
23. Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(2): 142-146.
24. Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist, 2013, 18(5): 533-542.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

甲狀腺/甲狀旁腺術后早期低鈣血癥誘發的清醒狀態下喉痙攣2例報道

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