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Objective To investigate the extent of reoperation for patients of differentiated thyroid carcinoma(DTC) who require total thyroidectomy.Methods The data of 137 patients undergoing reoperation for DTC were analyzed.These 137 patients were firstly diagnosed as benigh tumors and underwent local resection in our department from June 2004 to June 2010,however,they were proved to be DTC by postoperative pathology.Results In the reoperation,78 cases received ipsilateral residual thyroid resection plus contralateral lobectomy,11 cases received contralateral lobectomy,4 cases received contralateral near total lobectomy,22 cases received bilateral remnant resection,15 cases received ipsilateral remnant resection plus isthmuscectomy,and 7 cases received contralateral remnant resection.46 cases received unilateral cervical lymph node dissection,and 15 cases received bilateral cervical lymph node dissection.The incidence of temporary and permanent recurrent laryngeal nerve injury was 2.9％ (4/137)and 0.7％ (1/137) respectively.The incidence of temporary and permanent hypoparathyroidism was 3.6％ ( 5/137 ) and 1.5％ (2/137) respectively.There was no clinical evidence of recurrence or cervical lymph node metastasis during the 6 months to 6 years of follow-up.Conclusions For DTC patients after local resection,reoperation methods should be selected according to the first operation and pathological results.Careful operation can effectively reduce complications and improve prognosis.
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ObjectiveTo evaluate the mid- and long-term efficacy of subfascial endoscopic perforator surgery (SEPS)in the treatment CEAP classification C4 - C6 of primary chronic venous insufficiency(CVI). MethodsClinical data of 82 cases of chronic venous insufficiency were analysed retrospectively. According to operative method adopted,patients were divided into group A in which perforator veins were ligated under subfascial endoscopic surgery (SEPS group ),and group B in which perforator veins were not ligated (non-SEPS group).Diagnosis was established by clinical symptoms,color Doppler or ascending venography in all patients.Postoperatively patients were followed up regularly.The clinical outcomes between different surgicalmethods in two groups were assessed byCEAP clinical classification,CEAP clinical symptom scores,cumulative ulcer healing rate and cumulative ulcer recurrence rate.ResultsNo significant differences were found in CEAP clinical classification,CEAP clinical symptom scores between the two groups preoperatively ( P ＞ 0.05 ). There were significant differences in CEAP clinical classification such as edema,lipodermatosclerosis,venous ulceration between the two groups on 2 years postoperatively (P ＜ 0.05 ).The amount of swelling limbs,healed ulceration,active ulceration in group A was less than group B (P ＜ 0.05 ) on 3' and 5' years postoperatively.Significant differences were found postoperatively in total clinical symptom scores between group A and B.Clinical symptoms such as swelling,lipodermatosclerosis,ulcer healing in group A relieved more markedly than group B ( P ＜ 0.05 ).The median healing time of ulcers was 2.3 and 3.7 months respectively in group A and B.Log-rank test on group differences was sensitive to long-term cumulative ulcer healing rate ( x2 =4.063,P =0.044).But Breslow test on group differences was sensitive to early cumulative ulcer healing rate ( x2 =5.471,P =0.019).Cumulative ulcer healing rate in group A was significantly higher than in group B postoperatively (P ＜ 0.05 ).The cumulative ulcer recurrence rate in group A was significantly lower than group B (P ＜ 0.05).ConclusionsSuperficial vein resection combined with perforator vein ligation significantly enhanced clinical efficacy,accelerated ulcer healing and decreased mid- and long-term ulcer recurrence rate.
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Objective To compare complication between clamp harmonic scalpel and traditional pattern of bipolar electric knife in open thyroidectomy.Methods Patients undergoing open thyroidectomy from Jan.2009 to Dec.2010 in Thyroid Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University were analyzed retrospectively.Patients fell into 2 groups according to operative pattern:633 cases in clamp harmonic scalpel group and 587 cases in bipolar electric knife group.Complications such as intraoperative and postoperative blood loss,reooperative hemostatic rate,transient or permanent recurrent laryngeal nerve palsy,transient or permanent hypocalcaemia,and infection rate were compared.Results Compared with bipolar electric knife group,intraoperative and postoperative blood loss,reoperative hemostatic rate,transient recurrent laryngeal nerve palsy and transient hypocalcaemia in clamp harmonic scalpel group were significantly lower:(21.0 ±0.7)ml vs (10.0±0.3) ml,(31.0±1.1) mlvs (12.0±1.4) ml,1.53％ vs0.47％,2.39％ vs0.95％,1.87％vs 0.63％,and 3.58％ vs 1.73％ respectively(P ＜0.05).There was no significant difference in complications of permanent hypocalcaemia,permanent recurrent laryngeal nerve palsy and infection rate for the 2 groups:0％ vs 0％,0％ vs 0％,and 0.68％ vs 0.63％ respectively ( P ＞ 0.05 ).Conclusions Compared with traditional pattern of thyroidectomy,complication rate in clamp harmonic scalpel is significantly lower.Thyroidectomy by clamp harmonic scalpel is a safer operative pattern and worth to be popularized.
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MicroRNAs(miRNAs)are a class of small noncoding RNA molecules that function as posttranscriptional gene regulators by base-pairing with their target mRNAs where they either repress translation or direct destructive cleavage.Recent evidences have shown that miRNAs were aberrantly expressed in papillary thyroid carcinoma(PTC)compared with normal thyroid tissue,indicating that they may play a crucial role in the initiation and progression of PTC.Some deregulated miRNAs might potentially be adjunct markers in the preoperative diagnosis of papillary thyroid carcinoma.