Chung Jun-Young, Lee Yo Seob, Pyeon Seung Yeon, Han Sang-Ah, Huh Hyub
Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South Korea.
Department of Obstetrics & Gynecology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South Korea.
World J Clin Cases. 2022 May 6;10(13):4153-4160. doi: 10.12998/wjcc.v10.i13.4153.
Primary hyperparathyroidism (PHPT) is the most common cause of pregnancy-related hypercalcemia. PHPT can cause maternal and fetal complications in pregnant women. General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects. Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT. However, the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage.
A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy. The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior. Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL, and the parathyroid hormone level was elevated to 157 pg/mL. In a neck ultrasound, it revealed a 0.8 cm × 1.5 cm sized oval, hypoechoic mass in the upper posterior of the left thyroid gland, which was compatible with parathyroid adenoma. Superficial cervical plexus block (SCPB) for parathyroidectomy was performed. After surgery, the obstetrician checked the status of the fetus, and there were no abnormal signs. Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation.
Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.
原发性甲状旁腺功能亢进症（PHPT）是妊娠相关高钙血症最常见的病因。PHPT可导致孕妇出现母体和胎儿并发症。孕妇非产科手术的全身麻醉与母体风险以及对新生儿长期神经认知影响的担忧有关。妊娠中期手术切除病变目前是PHPT孕妇的主要治疗选择。然而，由于流产风险，手术应考虑的血钙浓度仍在讨论中。
一名31岁未生育女性，孕11周时因甲状旁腺切除术入院。该患者1年前孕16周时曾发生原因不明的宫内胎儿死亡。她的血液检查结果显示血清钙水平升高至12.9mg/dL，甲状旁腺激素水平升高至157pg/mL。颈部超声显示左甲状腺腺体内上后方有一个0.8cm×1.5cm大小的椭圆形低回声团块，符合甲状旁腺腺瘤。行甲状旁腺切除术的颈浅丛阻滞（SCPB）。术后，产科医生检查了胎儿情况，未发现异常体征。术后一周她的血钙水平恢复正常，孕38周时经阴道分娩一名体重2910g的健康男婴。
我们的病例表明，SCPB可以作为孕早期甲状旁腺切除术的一种麻醉选择。
