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Objective:To evaluate the clinical feasibility, safety, and advantages of small lateral cervical incision for parathyroid exploration and resection.Methods:A total of 31 consecutive patients who underwent parathyroidectomy with a small lateral cervical incision, in the Department of Endocrinology and Breast Surgery of the First Affiliated Hospital of Chongqing Medical University from Apr. to Nov. 2021, including 11 males and 20 females, aged (49.32±13.79) years, ranging from 28 to 86 years, were selected to make retrospective statistical analysis of the surgical time, hospital stay, intraoperative blood loss, postoperative drainage and postoperative complications of the patients. All patients were injected with carbon nanoparticles suspension injection guided by color ultrasound to locate the enlarged parathyroid gland before surgery. EXCEL 2019 software was used for statistical analysis.Results:Thirty-one patients underwent parathyroidectomy through a small lateral cervical incision. Primary hyperparathyroidism was performed in 19 cases (including 2 cases with bilateral small lateral cervical incision, 2 cases with unilateral excision of thyroid mass combined with parathyroidectomy, 1 case with resection of huge parathyroid adenoma, and 1 case with local anesthesia) . Twelve patients with secondary hyperparathyroidism underwent total parathyroidectomy through bilateral small lateral cervical incision and forearm autogenous parathyroid transplantation (including bilateral thyroid mass resection combined with bilateral total parathyroidectomy and forearm autogenous parathyroid transplantation in 2 cases, local anesthesia and cervical plexus nerve block in 2 cases, and ectopic parathyroid gland in thyroid in 1 case) . Among them, the average operative time of patients with primary hyperparathyroidism was (54.74±27.71 & 74.14±31.73) min, the average intraoperative blood loss was (8.11±5.05 & 14.43±10.94) ml, the average postoperative drainage was (14.37±24.64 & 26.36±32.87) ml, the average postoperative parathyroid hormone was (11.59±16.46 & 26.65±56.38) pg/ml, the average hospital stay was (10.00±5.09 & 10.96±4.55) d, and the postoperative complication rate was (3.2% & 0%) .Conclusions:Parathyroid gland exploration and resection through small lateral cervical incision is a safe and effective surgical method and can also complete thyroid exploration and parathyroidectomy at the same time. Appropriate anesthesia should be selected after a full assessment of the patient’s basic condition.
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Objective To study the correlation between hyperhomocystinemia and the property of cerebral artery plaque,and the pathogenic mechanism of hyperhomocystinemia resulting in acute cerebral stroke.Methods 60 patients with acute ischemic stroke were chosen.30 patients with normal homocysteine were classified as control group.The other 30 patients with hyperhomocystinemia were classified as observation group.High resolution magnetic resonance imaging(HRMRI) and multi contrast plaque imaging technique were used to measure the cerebral artery plaque burden,the fat ratio of plaques,the hemorrhage within the plaque and fibrouscap rupture.The number of inflammatory cells in the plaque and the density of the new blood vessels were identified using the transfer constant of the contrast medium.Results In the observation group,4 cases with low-risk plaques (13.33％),10 cases with middle-risk plaques (33.33 ％) and 16 cases with high-risk plaques (53.33 ％).In the control group,13 cases with low-risk plaques (43.33％),6 cases with middle-risk plaques (20.00％),11 cases with high-risk plaques (36.67％).The number of intraplaque hemorrhage were 18 cases (60.00％) in the observation group,and 8 cases (26.67％) in the control group.The number of fibrouscap rupture were 21 cases (70.00％) in the observation group,and 13 cases (43.33％) in the control group.Risk stratification of vulnerable plaques in cerebral atherosclerosis (U =-2.032,P =0.042),intraplaque hemorrhage (x2 =6.79,P =0.009) and fibrouscap rupture (x2 =4.34,P =0.037) in the observation group was higher than that in the control group.The number of inflammatory cells in plaques and the density of the new blood vessels in the observation group was (0.188 ± 0.265)Ktrans/min,which in the control group was (0.118 ± 0.183)Ktrans/min.The number of inflammatory cells in the plaque and the density of the new blood vessels in the observation group was higher than that in the control group (t =11.831,P =0.000).Conclusion Hyperhomocystinemia causes intraplaque hemorrhage,fibrouscap rupture,inflammatory cell activity and neovascularization in plaques,accelerates cerebral atherosclerosis and increases the incidence of ischemic stroke events.
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Objective To explore the effect of videos on health education to the spinal surgery patients during perioperative period. Methods About 99 patients with lumbar, cervical vertebra disease were randomized into two groups with random digit number:50 in the experimental group and 49 in the control group. Videos was used in the health education combined with routine health education model of perioperative health education in the former group and the health education was done in regular way in the control group. The two groups were compared in terms of hospital nursing service awareness, rehabilitation knowledge awareness, accuracy in perioperative nursing skill. Result The rate of knowledge about hospitalization nursing and the accuracy of rehabilitation nursing skills were significantly higher than those in the control group (P<0.05). Conclusions Video-assisted health education has changed the traditional way for health education, It is helpful for nurses to better implement health education program. It is beneficial for patients to strengthen memory. It can improve the perioperative knowledge and the accuracy in rehabilitation nursing skills.
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Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.
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Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.
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Objective To investigate the value of conventional ultrasound combined with contrast‐enhanced ultrasound in qualitative diagnosis of benign and malignant cervical lymph nodes (LNs) .Methods Totally 129 enlarged LNs in 112 cases were performed the 2‐dimensional ,color Doppler ultrasound ,and grey‐scale contrast‐enhanced ultrasound(CEUS)examinations .LNs were divided into the benign group and malignant group according to pathologic results .The aspect ratio ,eccentric medulla or medulla de‐fect ,echo type ,blood supply distribution ,contrast‐enhancement pattern and distribution equilibriuym of contrast agent were com‐pared between the two groups .Results The most of aspect ratio in the benign LNs group were ≥ 2 ,the cortex and medulla were uniform with symmetric increase and without microcalcification ,the blood supple was mainly the non‐blood flow type or hilar type , in contrast‐enhanced ultrasound ,the majority were the early hilar and medullar enhancement ,showing the centrifugally full filling ;the most of aspect ratio in the malignant LNs group were <2 ,medulla was eccentric or loss ,partial of LNs showed the increased parenchymal echo accompanied with cystic lesion and microcalcification ,the blood supply was mainly the peripheral and mixed types ,and the non‐hilar and medulla started enhancement pattern .The ultrasonographic parameters mentioned above were statisti‐cally different between the two groups ,in which the non‐hilar and medulla started enhancement patterns had the highest sensitivity and accuracy for diagnosing malignant LNs ,the positive predictive values of these parameters were higher ,whereas the negative predictive values were lower .Conclusion The conventional ultrasound combined with contrast‐enhanced ultrasonography has a higher practical value in qualitative diagnosis of cervical LNs ;the comprehensive judgment of multiple indicators can increase the differentiating ability for benign from malignant LNs .
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Objective To investigate the value of high frequency color doppler ultrasound for screening thyroid diseases in physi-cal examination people .Methods The detectable information of thyroid diseases using high frequency color doppler ultrasound in 1 413 physical examination people was analyzed .Results A total of 588 cases of the 1 413 people were detected to have thyroid dis-eases with positive rate of 41 .61% ,and the detectable rate increased with aging .The positive rate of female (349 cases ,54 .96% ) was statistically higher than that of male(239 cases ,30 .72% ) .Within the 588 people ,111 cases were diagnosed as diffused thyroid diseases and 488 cases were diagnosed as thyroid nodules by high frequency color doppler ultrasound .Twenty cases were confirmed to have thyroid carcinoma by pathologic examination ,with 3 males and 17 females .Twelve lesions were less than 1 .0 cm in diameter and were diagnosed as microcarcinoma .The smallest lesion was 6 mm × 5 mm .Conclusion The high frequency color doppler ultra-sound was useful in screening for thyroid diseases ,especially for carcinoma ,and should be used as routine examination item .