ABSTRACT
Objective:To explore the clinical effect of small incision endoscopic thyroidectomy in the treatment of differentiated thyroid cancer (DTC).Method:The clinical data of 63 patients with DTC in Anhui Wanbei Hospital were analyzed retrospectively. According to different surgical schemes, 33 patients who underwent complete endoscopic thyroidectomy were listed as the control group and 30 patients who underwent small oral endoscopic thyroidectomy were listed as the experimental group. The operation and postoperative recovery, immunosuppressive indexes (CD 3+, CD 4+, CD 8+, CD 4+/CD 8+) before operation and on the first and third day after operation, the levels of tumor indexes vascular endothelial growth factor (VEGF), thyroglobulin (Tg) before operation and one month after operation and the incidence of complications were compared between the two groups. Results:Compared with the control group, the operation time in the experimental group was shorter: (87.73 ± 15.35) min vs. (102.45 ± 20.78)min, t = 3.171, P = 0.002 ; the amount of intraoperative bleeding in the experimental group was shorter: (20.37 ± 5.26) ml vs. (44.25 ± 6.39) ml, t = 16.099, P<0.001 ; the incision length and the postoperative hospital stay in the experimental group were lower: (2.03 ± 0.14) cm vs. (2.58 ± 0.18) cm, t = 13.440, P<0.001; (4.58 ± 1.17) d vs. (6.02 ± 1.09) d, t = 5.057, P<0.001; the number of lymph node dissections in the experimental group was more: (6.20 ± 1.08) cases vs.(5.12 ± 1.13) cases, t = 3.869, P<0.001.Compared with before operation, the levels of CD 3+, CD 4+, CD 4+/CD 8+ decreased and CD 8+ increased in the two groups on the first day after operation, but the change range in the experimental group was small, and the experimental group recovered to the preoperative level on the third day after operation ( P>0.05). One month after operation, the levels of serum VEGF and Tg in the two groups were lower than those before operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). There was no significant difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Small incision endoscopic thyroidectomy in the treatment of DTC can achieve the same tumor treatment effect as complete endoscopic surgery, significantly shorten the operation time, reduce incision trauma and intraoperative bleeding, and reduce immunosuppression, which is conducive to postoperative rehabilitation and good treatment safety.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical diagnostic features and treatment of desmoplastic small round cell tumor (DSRCT), and to improve the understanding and management of this tumor.</p><p><b>METHODS</b>The clinicopathological data of nine patients treated in our hospital from October 2004 to June 2014 were retrospectively analyzed and a review of the literature was made. The clinical manifestations, pathological characteristics, diagnosis and differential diagnosis, treatment and prognosis of this tumor were summarized and analyzed.</p><p><b>RESULTS</b>Nine patients with DSRCT, 5 males and 4 females, with an average age of 21 years (range 8-56 years) were included in this study. Ultrasound examination revealed irregular low-density mass shadow in the abdominal cavity. CT examination found that 6 cases had abdominal and retroperitoneal multiple solid tumor nodules, uneven density, and visible low density fluid area. Postoperative pathological examination revealed that the tumor cells were small, mostly elliptic, gathered to form clear structure of nests with clear irregular boundaries. The central portion of large tumor nests often showed necrosis. Scattered fibroblasts and large amount of hyalinization of collagen fibers were seen in the interstitial tissue around the nests. Six patients received laparotomy surgery, however, all failed to resect the tumor completely. Three patients received postoperative chemotherapy, i. e. two cases had carboplatin and paclitaxel chemotherapy, and one case of chemotherapy regimen not specified. Two patients had radiation and chemotherapy (no concrete plan was available). Another case was lost to follow-up. Two of the three patients without surgery received chemotherapy with CAP (cyclophosphamide+adriamycin+carboplatin) and total rectal lesions, pelvic and inguinal lymph nodes, ilium metastases radiation therapy. Another one patient received EP regimen (DDP+VP16) which was then changed into a TP chemotherapy alone. Eight of the nine cases died shortly after surgery, and only one patient treated with chemotherapy alone was still alive after 11 months of follow-up.</p><p><b>CONCLUSIONS</b>Desmoplastic small round cell tumor is a very rare, special type of soft tissue tumor, with very poor prognosis. This tumor may be preliminarily diagnosed according to the imaging characteristics and detection of tumor markers, however, final diagnosis is made by pathology. Surgery is the priority of treatment, combined with complementary radiation and chemotherapy.</p>