Yamamoto H, Toyooka S
Department of Thoracic Surgery, Okayama University Hospital, Japan.
Kyobu Geka. 2012 Jul;65(8):720-3.
Patients with perioperative endocrine dysfunction represent a particular challenge to general thoracic surgeons. This article focuses on the 3 most commonly experienced endocrine disorders:diabetes mellitus, thyroid deficiency( hyper- and hypothyroidism), and long-term steroid administration. The point is to control those endocrine disorders as best as possible before surgery to avoid severe perioperative complications. For the patients with uncontrolled endocrine disorders who are presenting for elective surgery, their surgical procedures should be postponed. Surgeons should understand the clinical condition of their patients with endocrine disorders and closely coordinate with endocrinologists and anesthesiologists for the appropriate perioperative management. Diabetes mellitus is the most common endocrinopathy in patients presenting for surgery. Surgeons should be particularly careful for their surgical technique to avoid surgical site infection and bronchopleural fistula for diabetic patients undergoing lung resection. It is advisable to normalize thyroid function in hyper- and hypothyroidism because thyroid storm and myxedema coma are severe complications and the mortality of them is high. Perioperative steroid replacement therapy is necessary for the patients taking steroids according to the magnitude of the surgical stress to avoid perioperative hemodynamic instability due to adrenal insufficiency.
围手术期内分泌功能障碍患者对普通胸外科医生来说是一项特殊挑战。本文重点关注3种最常见的内分泌疾病：糖尿病、甲状腺功能减退（甲状腺功能亢进和减退）以及长期使用类固醇。关键在于在手术前尽可能控制这些内分泌疾病，以避免严重的围手术期并发症。对于因择期手术前来就诊但内分泌疾病未得到控制的患者，应推迟其手术。外科医生应了解内分泌疾病患者的临床状况，并与内分泌科医生和麻醉科医生密切协作，进行适当的围手术期管理。糖尿病是手术患者中最常见的内分泌病。对于接受肺切除术的糖尿病患者，外科医生应特别注意手术技巧，以避免手术部位感染和支气管胸膜瘘。对于甲状腺功能亢进和减退患者，使甲状腺功能正常化是可取的，因为甲状腺危象和黏液性水肿昏迷是严重并发症，且死亡率很高。对于正在服用类固醇的患者，根据手术应激程度进行围手术期类固醇替代治疗是必要的，以避免因肾上腺功能不全导致围手术期血流动力学不稳定。
