頸部広範囲手術後の副甲状腺機能障害について

HYPOPARATHYROIDISM AFTER NECK DISSECTION

　I．はじめに

　甲状腺癌，喉頭癌，下咽頭癌などに対する頸部の廓清手術の際に，その合併症の1つとして術後性副甲状腺機能低下症がおこることは広く知られている。Wölferの術後性テタニーの報告（1879）いらい甲状腺摘出後のテタニーの研究は数多くなされ，またその防止策としての手術法および治療法なども多くの報告がある。耳鼻咽喉科領域においても，喉頭癌，下咽頭癌に対して喉頭全摘出術，頸部廓清術などが行なわれ，そのさい甲状腺を全摘する事もあり，そのため頻度はそれほど多くないにしても術後性副甲状腺機能低下症がおこることがある。

　今回著者らは頸部手術後，副甲状腺機能低下症をおこし，異なつた経過を示した三症例を経験したので，若干の検討を加えここに報告した。

　Three cases of postoperative hypoparathyroidism after extensive neck surgery showing different clinical courses in each patient were reported. The first case was treated with only oral administration of calcium lactate and calcium gluconate. He showed no typical tetanic sign including numbness of hands and feet, but serum calcium levels were under normal range throughout postoperativedays. He finally died of pneumonia.

　The second case showed few tetanic attacks and was treated with intravenous injection of calcium gluconate and calcium chloride and with oral calcium lactate and vitamin D-2, but he was dead of heart failure during tetanic attack.

　The third case showed a attack of tetany and was treated with intravenous injection of calcium gluconate. He was also treated with oral administration of calcium lactate and 1-a -OH -D-3. About a week later his serum calcium level became within normal range and he has been in good condition.