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The set of guidelines for the diagnosis and treatment of thyroid nodules and differentiated thyroid cancer (the second edition) was published in 2023 in China. Based on the first (2012) edition, the current set was revised jointly by nearly 100 experts in endocrinology, thyroid surgery, oncology, nuclear medicine, ultrasound medicine, and pathology from seven national societies for one year. The new version of the guideline is still divided into two parts, namely, thyroid nodules and differentiated thyroid cancer. The writing mode of asking clinical questions, explaining and giving recommendations is adopted, and a total of 117 recommendations are provided. This article aims to compare the variations in the differentiation of benign and malignant thyroid nodules and surgical treatment of differentiated thyroid cancer between the new and old versions from the perspective of surgery. The author's own understanding and experiences are also discussed.
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Objective:To explore the impact of the clinicopathological characteristics of patients on the invasiveness of thyroid papillary carcinoma, especially the impact of Hashimoto’s thyroiditis.Methods:A retrospective analysis of the medical records of 5,018 patients with papillary thyroid carcinoma who were admitted to the Center for Thyroid Diseases of the First Affiliated Hospital of Kunming Medical University from Apr. 2012 to Dec. 2018 was conducted. Among them, 166 cases were excluded due to incomplete data, 394 cases with family history, 55 cases with hyperthyroidism or other thyroid diseases, 39 cases with other malignant tumors or history of radiotherapy and chemotherapy, and 548 cases with abnormal serum TSH (decreased or increased) . After screening, a total of 3816 cases were included in this study. Observation indicators included gender, age, tumor size, extraglandular invasion, vascular invasion, Hashimoto and serum TSH levels. The serum TSH results of the 3816 patients included in this study were all normal. The invasiveness of PTC was predicted by statistical analysis of tumor extraglandular infiltration and tumor size. The study used SPSS 23.0 statistical software for analysis, univariate analysis was made by non-parametric tests ( χ2 test and rank sum test) , multivariate analysis was made by Logistic regression and linear regression analysis, and the differences were statistically significant at P<0.05. Results:Multivariate logistic regression analysis showed that tumor size [ β=0.696, P<0.001, OR (95% CI) =2.006 (1.827-2.204) ], vascular invasion [ β=0.772, P<0.001, OR (95% CI) =2.165 (1.546-3.031) ], Hashimoto [ β=-0.303, P=0.006, OR (95% CI) =0.739 (0.596-0.915) ] had an independent effect on extraglandular infiltration. The results of linear regression analysis of tumor size showed that gender ( β=0.082, P<0.001) , age ( β=-0.134, P<0.001) , extraglandular infiltration ( β=0.268, P<0.001) , vascular invasion ( β=0.076, P<0.001) were independent influencing factors for tumor size. Conclusions:Lage tumor size and the presence of vascular invasion are independent risk factors for extraglandular invasion of PTC, and HT is protective factor. Male, age ≤45 years old, presence of extraglandular invasion and vascular invasion are independent risk factors for tumor size of PTC. The clinical significance and mechanism of the difference in the effect of Hashimoto’s thyroiditis on the extra-gland infiltration of thyroid papillary carcinoma remains to be further studied.
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With the increasing incidence of thyroid cancer, more and more thyroid operations are being performed.The relationship between parathyroid gland and thyroid gland is closed and complex, and parathyroid gland’s location is changeable and its blood supply is fragile.Hypoparathyroidism caused by the damage of parathyroid gland has become one of the common postoperative complications.The causes of injury or dysfunction of parathyroid gland are various, which are not only related to anatomical factors, including the variation in morphology, colour, quantity, location and blood supply, but also related to the operation skills of the surgeon or the use of energy devices, while the destruction of blood supply and tissue thermal damage are the main reasons.Therefore, expert mastery on the anatomical location of parathyroid gland and distribution of blood supply of parathyroid gland, careful anatomy during the operation to prevent accidental removal of parathyroid gland, rational use of energy devices to prevent mechanical damage of parathyroid gland and blood supply and thermal damage, is conducive to improving protection of parathyroid function and can reduce the occurrence of postoperative hypoparathyroidism.
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Objective:To evaluate the feasibility, safety and effectiveness of the active surveillance as an alternative to surgery in patients with low-risk papillary thyroid microcarcinoma(PTMC); And to explore potential surgical indicators based on characteristics of patients and medical environment.Methods:A prospective cohort study was conducted in patients with low risk PTMC and received active surveillance management( n=98). Patient adherence, non-progression surgery rates were described, cumulative incidence of tumor growth≥3 mm and tumor volume increase≥50% under ultrasonic monitoring, as well as tumor doubling rate(TDR) were evaluated. Results:A total of 98 patients were enrolled in this prospective cohort. The median age was 39(30, 45) years, and the median baseline diameter of the index tumors was 5.0(3.8, 6.8) mm, with 63.3% of tumors being≤5 mm. After a median 22(12, 44) months follow-up, tumor size growth≥3 mm and tumor volume increase≥50% occurred in 11(11.2%) and 50(51.0%) patients, and no new lymph node metastasis, distant metastasis, and death occurred. Five cases(5.1%) required delayed surgery, and other five non-progression patients opted in surgery based on their own preferences. One patient lost to follow-up. The median post-tumor progression TDRs was significantly lower than that of pre-tumor progression TDRs [size growth per year: -0.09(-0.12, 0.48) vs 0.91(0.86, 1.25), P=0.014, n=8; volume increase per year: 0.29(-0.14, 0.70) vs 1.04(0.66, 2.17), P<0.001, n=39]. After tumor size and volume progression, 62.5% and 43.6% of tumors were remained stable or shrank, respectively. Conclusions:Actived surveillance can be considered as one of the management strategies for low-risk PTMC. Given the differences in population and clinical characteristics, it should be taken in to consideration in developing active surveillance management, such as candidate criteria, follow-up strategies, and intervention indications.
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Objective To probe the reasonable range of central lymph node dissections(CLNs)for papillary thyroid carcinoma (PTC) in cN0 T1/T2 by analyzing the metastasis regulations of PTC in cN0 T1/T2.Methods Data of 891 PTC patients in cN0T1/T2 cases according to the research criterion from Oct.2013 to Sep.2017 were analyzed.All the patients were under the treatment of the same group of surgeons in Department of Thyroid Surgery of the First Affiliated Hospital of the Kunming Medical University and had undergone operation of bilateral total resection of thyroid gland and central lymph node.The clinical and pathological data were collected.Univariate and multivariate analysis were used to investigate the risk factors of central neck lymph node metastasis and high volume central neck lymph node metastasis.Results ①Univariate analysis showed that gender (P=0.002),age(P=0.002),multiform(P=0.000),nodular goiter(P=0.000)and with Hashimoto's(P=0.031)had significant influence in prevalence of CLN node metastasis.Gender(P=0.010)and tumor size(P=0.000)showed significant influence in prevalence of high volume CNL node metastasis.In multivariate analysis,age (OR=0.962,OR=2.856)and nodular goiter(OR=0.969,OR=3.012)showed the independent risk factor of CNL node metastasis and high volume CNL node metastasis.②The numbers of lesion in unilateral lesion were not correlated with IpsiCLNs and Cont-CLNs metastasis (P=0.347,P=0.653).The tumor diameter was correlated with Ipsi-CLNs and ContCLNs metastasis (P=0.010,P=0.000).The tumor diameter of bilateral multifocal carcinoma was correlated with LN-prRLN-CLNs metastasis (P=0.019).The tumor diameter of left and right unilateral single focal lesion was not correlated with LN-prRLN-CLNs metastasis(P=0.684,P=0.072).Conclusions According to the study,it is recommended that the PTC in cN0 T1/T2 should routinely undergo preventive central lymph nodes dissection in the case of technical support:①Preventive overall CLND is recommended for unilateral non-microscopic carcinoma and bilateral multiform carcinoma,especially in those older than 55.②For patients with unilateral single or multifocal microscopic carcinoma,only ipsilateral central lymph nodes dissection can be considered.③ Generally,routine dissection is not necessary for the lymph nodes of the right recurrent laryngeal nerve in the central region of the neck.However,for bilateral non-small cancers and right non-small cancers,LN-prRLN-CLNs dissection is recommended.
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Objective: To investigate the anatomical characteristics of the parathyroid lymphatic system and the mechanism of the"negative development"of the carbon nanoparticles for parathyroid gland in thyroidectomy.Methods:This retrospective study used parathyroid tissue samples from patients that were obtained from archival records in the pathology department,including 45 cases of normal parathyroid gland tissues that were accidentally resected in thyroidectomy,10 cases of parathyroid adenomas,and 7 cases of parathyroid carcinoma.Ten cases of normal thyroid tissues were selected as positive control.Immunohistochemistry was performed using the antibodies specific for lymphatic endothelium,such as D2-40 and LYVE-1,and antibodies specific for vascular endothelial cell such as CD31 and CD34,to distinguish them from each other.Results:A total of 62 parathyroid glands samples were stained with vas-cular markers CD31,CD34 and lymphatic markers D2-40,LYVE-1 respectively(partial samples were stained unsuccessfully).Vascular vessels in the CD31 staining group were detected in 50 of 58 examined glands and the positive rate was 86.2%.In the CD34 staining group,positive rate was 100%(60/60).The positive cells were found in the central,periphery and vascular hilum of the glands.Howev-er,lymph vessels in the D2-40 staining group were detected from 17 out of 59 examined glands,with the positive rate of 28.8%;In the LYVE-1 staining group,positive rate was 39.6%(23/58).The positive cells were found in the membrane or vascular hilum,less frequent or undetectable in the central portion.Conclusions:Most of the parathyroid glands of adults might lack a lymphatic network.Only a few adult parathyroid glands had minority lymph vessels,and these lymphatics generally localized at the membrane area or in the vas-cular hilum, which could be one of the main and anatomical mechanisms resulting in drainage failure or obstruction of carbon nanoparticles and thus in parathyroid"negative development."
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Objective@#To evaluate the application of the central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) in cN0 T1/T2.@*Methods@#Retrospective analysis of 532 cases with PTC in cN0 T1/T2 who underwent CLND between October 2014 and September 2016 in the Department of Thyroid Surgery, the First Affiliated Hospital of the Kunming Medical University. The incidence of central lymph node (CLN) metastasis and risk factors were analyzed.@*Results@#CLN metastasis rates: 41.2% (42/102) in males vs 34.9% (150/430) in females, P=0.252; 33.9% (116/342) in single focal carcinoma vs 40.4% (74/183) in multifocal carcinoma, P=0.157; 44.0% (125/284) in patients with 45 years old or less vs 27.0% (67/248) in patients more than 45 years old, P=0.000; 30.3% (113/373) in microcarcinoma vs 50.9% (81/159) in non-microcarcinoma, P=0.000.In unilateral lesions, ipsilateral CLN metastasis was correlated with the tumor diameter (P=0.012), but not with the number of lesions (P=0.653). also contralateral CLN metastasis was correlated with the tumor diameter (P=0.000), but not with the number of lesions (P=0.815). For the left or right unilateral single focal lesion, the tumor diameter was not correlated with the metastasis of the posterior to right recurrent laryngeal nerve central lymph nodes (LN-prRLN-CLN) (P=0.652, P=0.088). But in bilateral multifocal carcinoma the tumor diameter was correlated with metastasis of LN-prRLN-CLN (P=0.039).@*Conclusions@#Prophylactic CLND is reasonable for PTC in cN0 T1/T2. A bilateral CLND should be conducted for patients with bilateral multi-focus cancer and unilateral or bilateral non-microcarcinoma, especially in patients more than 45 years old. For unilateral single focal microcarcinoma on the right, the content of CLND should be from laryngeal nerve on right center to posterior branche; for unilateral single focal microcarcinoma on the left side, the left CLND should be conducted. An ipsilateral CLND can be considered in patients with unilateral multifocal microcarcinoma, and generally a routine dissection of the LN-prRLN-CLN is not required, however for bilateral non-microcarcinoma and the the non-microcarcinoma on the right side, the LN-prRLN-CLN dissection should be conducted.
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Objective To study the effect of temporary in vitro preservation of parathyroid on the activity of cells in the process of parathyroid auto-transplantation and function of postoperative in order to improve the survival rate of transplantation.Methods (1)Experimental rabbits for the study were randomly divided into three groups:group A,group B,group C,with 8 rabbits in each group.Then we remove the bilateral inferior parathyroid,in group A,the parathyroid glands were immediately formaldehyde-fixed;in group B and group C,the parathyroid glands were placed in normal saline in 4 ℃ and in room temperature (22-24 ℃) for 30 minutes respectively and then fixed;HE staining was performed on the left parathyroid glands to observe the morphology of the cells;Electron microscopic examination of the right parathyroid glands were performed to observe the ultrastructural changes of the cells.(2)Experimental rabbits were randomly divided into three groups:group D group E and group F,with 8 rabbits in each group,after total thyroidectomy,the double inferior parathyroid glands were took out,in group D,the parathyroid glands were immediately transplanted in bilateral anterior cervical muscles;in group E and group F,the parathyroid glands were placed in normal saline 4 ℃ and in room temperature (22-24 ℃) for 30 minutes respectively and then transplanted.All animals were monitored of serum calcium and PTH on preoperative 1 d and postoperative 1 d,3 d,5 d,7 d;the parathyroid was took out for HE staining to observed survival of parathyroid tissue and pathology damage when 7d after operation.Results (1) The normal parathyroid gland is mainly dominated by the chief cells,the nucleus of the chief cell was round and centered under electron microscope;there were no significant change in the morphology of parathyroid cells,and the mitoehondria of the cells were slightly swollen under 4 ℃;but the parathyroid gland cells were slightly swollen and partially vacuole degeneration,the morphology of the nucleus was irregular,and the mitochondria were extremely swollen and deformed,and the ridge was broken under room temperature.(2)three groups of rabbits after transplantation of parathyroid,serum calcium and PTH decreased significantly,and increased gradually,there was significant difference on the 7th day after the operaion between the two groups (P＜0.05);(3)in group D,the normal parathyroid cells densely distributed in the anterior cervical muscle tissue;in group E,A large number of parathyroid cells survived in muscle tissue,with some vacuolated;in group F,only part of healthy parathyroid ceils scattered in the muscle.Conclusion Parathyroid should be preserved in 4 ℃ normal saline during the operation,and the transplant should be completed in 30 minutes as far as possible.
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Objective To study the effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid,through establish an animal model by simulating total thyroidectomy and parathyroid damage during surgical operation.Methods Experimental rabbits for the study were randomly divided into A,B,C,D four groups (n =8),Group A (control group):simple exposure,exploration thyroid and parathyroid;group B (vascular injury group):total thyroidectomy and ligation bilateral parathyroid blood supply but keep the surrounding membrane;Group C (membrane damage group):total thyroidectomy and damage membrane but reservations blood supply.Group D (composite damage group):total thyroidectomy plus membrane and blood both damage;All animals were monitored of serum calcium and PTH,preoperative 1 days and postoperative 1 st day,3rd day,5th day,7t day;cut the parathyroid HE staining to observed survival of parathyroid tissue and pathology damage when 7th day after operation.Results (1) Animals in each group preoperative serum calcium and PTH were no significant difference (P ＞0.05);(2)Group A postoperative serum calcium decreased,but at 5th day returned to preoperative level (P ＞ 0.05);Group B and C postoperative 1st day,3rd day,5th day serum calcium decreased significantly(P ＜ 0.05)and to the lowest at 1 d and then gradually recovered,but group C faster recovered than group B (P ＜ 0.05);Group D postoperative 1 st day,3rd day serum calcium continued to decline significantly (P ＜ 0.05);(3) Group A postoperative serum PTH decreased,but at 7th days returned to preoperative level (P ＞ 0.05).Group B and C postoperative 1st day,3rd day,5th days serum PTH decreased significantly(P ＜0.05)and to the lowest at 1 d and then gradually recovered,but from postoperative 3rd day group C faster recovered than group B(P ＜ 0.05);Group D postoperative 1 st day,3rd day serum PTH continued to decline significantly (P ＜ O.05);(4) Pathology results:Group A parathyroid filled with chief cells and a small amount of vacuolar changes (5％ to 10％);Group B parathyroid hemorrhage,necrosis (40％ to 50％),part of the cell degeneration (30％ to 40％),center with fibrosis,seen granuloma and hyperplasia of parathyroid tissue in surrounding;Group C parathyroid bleeding (10％ to 20％),part of the cell degeneration (10％ to 20％);Group D parathyroid severe necrosis,almost no normal parathyroid tissue,significant fibrosis,less residual parathyroid tissue was scattered.Conclusions (l) The recover of Parathyroid function is influenced by the type of parathyroid in situ injury during thyroidectomy,composite damage of blood supply and membrane of parathyroid is the most serious,parathyroid ischemia necrosis,the function can not be restored,pure blood supply damaged,some can restore function,and the parathyroid gland with vascular pedicle can be recovered quickly.(2) Severe blood supply and membrane damaged,and even free parathyroid should be transplanted immediately during operation.
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Postoperative hypothyroidism is the most common complication following thyroidectomy,and thyroxine replacement is needed to maintain thyroid function.Levothyroxine (L-T4) is the preferred drug for the treatment of hypothyroidism.L-T4 therapy can be initiated immediately after thyroid operation,and the dosages are influenced by target serum TSH and several other factors.Special consideration should be taken for such patients,including patients with poor compliance,during pregnancy,and elderly patients.Thyroid function should be measured every 4 to 6 weeks,optimal dosages are adjusted according to target serum TSH individually,avoiding under-treatment or over-treatment.T3 in divided doses or L-T4/T3 combination therapy can be served as alternative for those failed to L-T4 therapy alone.
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Objective To explore the dynamic variation rule of drainage fluid parathyroid hormone ( dPTH) , serum parathyroid hormone ( PTH) and serum calcium after thyroidectomy .According to the variation rule, the survival , function and prognosis of the parathyroid which retained at the original place can be predicted . Methods From Apr.2012 to Aug.2012, 90 patients who underwent thyroidectomy in Thyroid Surgery Center of the First Affiliated Hospital of Kunming Medical University were chosen as the research object .All of the objects'operations were performed by the same surgeon team and they were divided into four groups according to different surgical methods ( group A:bilateral thyroidectomy group , group B:bilateral thyroidectomy and central neck dis-section group , group C: bilateral thyroidectomy and functional neck dissection group , and group D: unilateral thyroidectomy group ) .Parathyroid retention situation during operation and the occurrence of hypocalcaemia after operation were recorded .Blood samples were taken between 7am and 8am in the 4 consecutive days after opera-tion to detect serum calcium and serum parathyroid hormone .All of the 90 patients had the drainage tube and their drainage fluid were taken for testing dPTH .The levels of serum calcium , PTH and dPTH were analyzed by statistical analysis of repetitive measure analysis of variance ( ANOVA) .Results The mean postoperative maxi-mum serum calcium was in group D and the minimum was in group C .There was no obvious difference in terms of serum calcium between group A and group B .However , the serum calcium showed an upward trend in each group.The mean postoperative maximum PTH was in group D and the difference has statistical significance com -pared to the other 3 surgical methods.The minimum was in group B and group C .However, it showed an upward trend with time in each group .The difference of dPTH in each group had no statistical significance and it showed a downward trend in all the 4 groups.Low serum calcium and hypocalcaemia occurred to 22 cases and 13 cases respectively after operation .The low serum calcium cases in each group were 12, 3, 4 and 2 respectively and hy-pocalcaemia cases in each group were 4, 3, 1 and 1 respectively.Conclusions By monitoring dPTH, PTH and serum calcium after thyroidectomy , the survival and function of parathyroid retained at the original place can be e-valuated comprehensively .Furthermore, it also helps to estimate prognosis .dPTH at a high level after operation is a direct evidence that parathyroid retained at the original place survives .Low PTH and high dPTH after thyroid-ectomy illustrates the operation just affects the way that PTH secreted into blood and the parathyroid retained at the original place can still secrete large amount of PTH .PTH will return to normal gradually with reconstruction and healing of microcirculation around parathyroid .Persistent low serum PTH after operation , low dPTH after 24 hours and the early advent of hypocalcaemia suggest the parathyroid retained at the original place was injured seri -ously and its blood supply was damaged obviously and more than one parathyroid were affected .Secretion function of parathyroid will remarkably decrease .
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Objective:To define the role of lymph tracers in lymph node dissection and pathological examination of papillary thyroid carcinoma. Methods:Patients with papillary thyroid carcinoma who met inclusion criteria were enrolled and randomly assigned into the three groups, namely, carbon nanoparticle (CN), methylene blue (MB), and conventional surgery (CS) groups. The number of detected lymph nodes in each group was summed, and pathological examination was conducted. Histological examination of the lymph node specimens in the tracer group was performed based on the classification of staining and nonstaining groups. Results:Major complications such as anaphylaxis did not occur after injection of CN and MB. The average of the detected lymph nodes was higher in the tracer group than in the CS group, and the detection rate of the lymph node was higher in the CN group than in the MB group. In addition, the rate of cancer metastasis was higher in the group with stained lymph node than in the group with unstained lymph node. The index of the CN group was higher than that of the MB group. Conclusion:The tracing effect and lymphatic tropism of CNs were stronger than MB. The thyroid lymph tracer technique may promote the normalization and thoroughness of lymph node dissection in thyroid cancer.
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Thyroid cancer spreads predominantly via the lymphatics to the local draining lymph nodes.This is a review about it.We also report about the role of sentinel node biopsy in thyroid cancer.
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Objective To discuss the influence of preventive calcium supplementation on the recovery of parathyroid glands function after total thyroidectomy.Methods 232 patients meeting the selected criteria were randomly assigned to group A and B,and then divided into group A1 (87 cases,PTH ＞8 pg/ml)and A2 (30 cases,PTH ＜8 pg/ml),group B1(83 cases,PTH＞8 pg/ml)and B2(32 cases,PTH ＜8 pg/ml) based on the lowest parathyroid hormone( PTH )value within 3 days after surgery.All patients in group A were immediately supplemented 10％ calcium gluconate intravenously 6 g/d after operation.For group B,post operative calcium supplementation was not given,however,anyone whose PTH ＜ 8 pg/ml was supplemented 10％ calcium gluconate intravenously 6 g/d no matter hypocalcemia occurred or not.The level of serum calcium and PTH of all patients were assayed before operation and at the 1st,2nd,3rd day,1st week and 1st month after operation.In additon,patients with hypocalcemia received serum calcium and PTH detection at the 2nd and 3rd week.Whether hypocalcemia and hypoparathyroidism occurred or not was recorded.Results ( 1 )The serum PTH was obviously higher in group A1 than in group B1 at the 1st week after operation( P ＜0.05 ).The serum calcium was obviously higher in group A1 than in group B1 at the 1st,2nd,3rd day and 1st week after operation(P ＞0.05).The hypocalcaemia and symptomatic hypocalcaemia incidence were obviously lower in group A1 than in group B1 (P ＜ 0.05 ).(2)① Group A2 had obviously higher level of serum PTH than group B2 at the 1 st,2nd,and 3rd week after operation ( P ＜0.05 ) and returned to normal level of serum PTH earlier than group B2.② Group A2had obviously higher level of serum calcium than group B2 from the 1 st day to the 3rd week after operation ( P ＜ 0.05 ) and returned to normal level of serum calcium earlier than group B2.③ The hypocalcaemia and symptomaic hypocalcaemia incidence ware obviously lower in group A2 than in group B2 (P ＜ 0.05 ).Conclusion The preventive calcium supplementation is beneficial for the recovery of the function of parathyroid glands after total thyroidectomy.
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Objective To establish a rat model of acute lung injury (ALI) induced by intraperitoneal injection of pancreatitis associated ascitic fluids (PPAF) and perforative peritonitis ascitic fluids (PAAF).A secondary objective is to study the non-specificity of acute lung injury induced by PAAF.Methods Acute necrotizing pancreatitis (ANP) model and perforative peritonitis (PP) model were established in 120 rats,from which the PAAF and PPAF were collected.Forty-eight rats were randomly divided into three groups:normal saline (NS) group,PAAF group,and PPAF group.Within each group,they were randomly sacrificed at 7h and 12h of surgery.The pathological severity of the lung injury,wet/dry ratio,MPO (myeloperoxidase) in lung,and apoptosis rate of pneumocytes were evaluated and analyzed.Results Lung injury,wet/dry ratio,MPO in lungs,and cell apoptosis were significantly higher in the PAAF group and PPAF group than in the NS group (P＜0.01).However,there was no significant difference between PAAF group and PPAF group (P＞0.05).Conclusions Both PAAF and PPAF can induce acute lung injury in rats by intraperitoneal injection.However,the acute hung injury induced by PAAF has limited specificity.
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TSH suppression therapy plays an important role in differentiated thyroid carcinoma. It can lower mortality and recurrence rate in high risk patients. Meanwhile, it also has potential side effects on cardiovascular and skeletal systems. Thus, TSH suppressive therapy should be individualized in regard to its possible benefit and potential adverse effects.
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BRAFV600E mutation is the most common genetic alteration in the papillary thyroid carcinoma.It plays an important role in the tumorigenesis,invasiveness and metastasis of the papillary thyroid carcinoma.Testing of BRAFV600E mutation is of great value in diagnosis,which also can be used as a prognostic maker of papillary thyroid cancer.Inhibitors treatment targeted to BRAF kinase and its downstream effectors is a new area in the treatment of BRAFV600E mutated thyroid cancer.
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Objective To investigate the cause of reoperation for high differentiated thyroid carcinoma and the risk factors of neck lymph node metastasis in reoperation. Methods Retrospectively reviewed the clinical data of 54 high differentiated thyroid cancer patients from 1998 to 2005, who received reoperation and neck lymph node dissection simultaneously. Results The residual thyroid carcinoma rate and lymph node metastasis rate were higher in 39 patients who initially received partial thyroidectomy than in 15 who previousely underwent radical operation(P <0. 05). Age less than 45 years, lymphadenectasis before initial operation, tumor residued or relapsed, muhicentricity of primary cancer and blurred boundary between cortex and medulla of lymph node were the risk factors for ipsilateral lymph node metastasis(P <0. 05), while mul-ticentricity of primary cancer and contralateral thyroid cancer were the risk factors for contralateral lymph me-tastasis (P < 0. 05). Conclusions Individual standard radical operation and necessary lymph node dissection are important measures to prevent recurrence and reoperation. Completion thyroidectomy and modified or selec-tive neck dissection are recommended for reoperation patients with the risk factors of lymph node metastasis.
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Abdominal drainage is the most common technique applied in the abdominal surgery. According to the aim of drainage, it can be divided into curative drainage and preventive drainage, but there is no obvious difference between the 2 drainages. Abdominal drainage is not necessary after parenchymal viscera operation, but necessary after spleenectomy in preventing infection. For cavity viscera operation, abdominal drainage is applied according to the infectious condition, but scholars at home and abroad have different opinions on this point. Surgeons should pay attention to the placement of the drainage tube in patients who received preventive drainage.
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In early stage of the severe acute pancreatitis, mediators of inflammation make the permeability of the microcirculation blood vessel increasing and more fluidify aggregates in tissue space. Pancreatic tissue is dropsical and necrotic ; a great quantity of body fluid accumulates in abdominal cavity, which induce utility circulation volume and returned blood volume decreasing rapidly. As more and more utility circulation volume decreases, the blood current of the coronary arterY is insufficient and the cardiac muscle cell is ischemic, the cardiac muscle is suffering injury to different extent. The cardiac load is overweight relatively. The cardiac muscle fiber is prolonged and interchanged idand cardiac muscle cellular membrane is damaged. The chain reaction and magnification of the mediators of inflammation let body delivery generous cell factors such as TNF-α,interleukin, oxygen free radical and so on, which make cardiac muscle cell's integrality damage,apoptosis,cardiac functional disturbance even exhaustion. In addition, abdominal compartment syndrome,pancreatitis associated ascetic fluid and electrolyte disturbances etc are also the important factors that affect the development of the disease.