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Objective To investigate the related factors of central regional lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC).Methods The clinical and pathological fea tures of 550 cases of PTMC with clinical lymph node negative (cN0) were retrospectively analyzed.x2 test and multivariate logistic regression analysis were used to analyze the related factors of CLNM.ROC curve was used to analyze tumor diameter and CLNM of PTMC.Results The CLNM rate was 35.6％.Univariate analysis showed that patients aging less than 45 y(x2=13.983,P＜0.001),with tumor diameter≥7 mm (x2=14.263,P＜0.001),with capsule invasion (x2=7.316,P=0.006),multifocality (x2=14.321,P＜0.05) and bilateral tumors (x2=9.265,P=0.002) were more likely to have CLNM.Multivariate Logistic regression analysis showed that age ＜45 y,tumor diameter ≥7 mm,invasion of capsule and multifocal are all independent risk factors of CLNM for patients with PTMC.The optimal cutoff value of CLNM by diameter was 8 mm.Conclusion The CLNM of PTMC is related to many factors.When the age of the patient is less than 45 y,the diameter of the tumor is more than 7 mm,the invasion of the capsule and the multifocal lesion,the central lymph node dissection should be performed.
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Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma( cN0-PTMC) and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients(34.8%)had cervical lymph node metastasis (30.0%in central region and 9.9%in lateral region). For patients with tumor diameter ( D)≤5 mm and D>5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%(χ2 =6.199,P45 years old was 37.9% and 21.1% respectively (χ2 =7.792, P 5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.
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OBJECTIVE@#Through preoperative temporary balloon occlusion of internal carotid artery and monitoring of carotid artery stump pressure variation, in order to further predict the risk of carotid artery ligation and resection, evaluation operative risk and provides the reference for the choice of surgical approach.@*METHOD@#Continuous monitoring and recording the carotid artery stump return pressure,before clamping and in the process of blocking, close observation the patients mental state and the nervous systemof all kinds of signs, in the process of blocking, to understand the dynamic change of stump artery pressure return in patients and whether can the smooth passage of carotid artery balloon occlusion test.@*RESULT@#Of the 19 patients, 4 cases were positive, 15 negative cases, Blocking immediate the positive patients and negative patients with stump pressure drop was (57. 35 ± 1. 89) % and (38. 99 ± 12. 23) %, with statistical significance between the two, in the process of blocking, the mean stump pressure of the positive patients and the negative patients was (37. 29 ± 3. 15) mmHg and (61. 36 ± 14. 69) mmHg, with statistical significance between the two.@*CONCLUSION@#Approximately 21. 05% of patients can not tolerate carotid artery balloon occlusion test, theory for carotid artery reconstruction operation. After blocking the stump pressure is less than 40. 44 mmHg, the theory for reconstruction of the internal carotid artery operation. Blocking instant artery stump pressure dropped more than 55. 46%, in theory the need for internal carotid artery reconstruction.
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Humans , Balloon Occlusion , Blood Pressure , Carotid Artery, Internal , General Surgery , Feasibility Studies , Ligation , Preoperative Care , Risk Assessment , Vascular Surgical ProceduresABSTRACT
Objective To study the anatomic landmarks of recurrent laryngeal nerve (RLN) in minimally invasive video-assisted thyroidectomy (MIVAT), and to evaluate the operative skills to avoid nerve injury. Methods 106 patients were enrolled in the study dated between August 2008 and August 2010, in which 8 patients were converted to the conventional thyroidectomy. Intraoperative anatomic landmarks for location of RLN were the gap between trachea and carotid artery (GTC), as well as the middle and posterior portion of tracheal wall. Results 98 RLN were at risk, and 97 (98.98 %) nerves were recognized by means of two landmarks. 1 nerve failed to locate which was non-recurrent laryngeal nerve. Temporary RLN paralysis happened to 1 nerve(1.02 %), and no permanent RLN paralysis appeared. Conclusion GTC combined with middle and posterior portion of tracheal wall are safe and effective anatomic landmarks to locate RLN in MIVAT.
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OBJECTIVE To construct the lentiviral vector system expressing MDR1 small interference RNA, and identify reversal efficiency of multidrug resistant phenotype in the human laryngeal cancer multidrug resistance cell lines (LSC-1/TAX). METHODS Three target sequences of oligonucleotides were selected according to MDR-1 gene sequence, the complementary DNA contained both sense and antisense strands were designed and synthesized. After the oligonucleotides were inserted into the plasmid expression system pLVTHM, the plasmid was cotransfected along with pCMV-dR8.74 and pMD2G into 293T cell lines to package lentiviral particles. Interference efficiency of the lentiviral vector system expressing MDR1 small interference RNA was determined by RT-PCR, real time PCR and Western Blot in the human laryngeal cancer multidrug resistance cell lines (LSC-1/TAX), drug resistance was measured by MTT assay after interference. RESULTS It was confirmed by digestion and sequencing that lentiviral vector had the correct structure and could express the GFP and siRNA. The functional titer of concentrated virus was more than 1?108TU/ml. The vectors expressing 3 target sequences can infect LSC-1/TAX, and the third vector has the best interference efficiency. CONCLUSION The lentiviral vector system expres-sing MDR1 siRNA has been constructed, which is necessary to reverse multidrug resistance phenotype in the human laryngeal cancer multidrug resistance cell lines