Recurrent laryngeal nerve inlet zone lymph node metastasis in papillary thyroid cancer / 中华普通外科杂志

Objective:To explore the clinical significance of recurrent laryngeal nerve inlet zone(RLNIZ) lymph node metastasis in papillary thyroid cancer(PTC).Methods:The clinical data of the clinicopathologic characteristics of 738 cases with papillary thyroid cancer at our centers from Jul 2017 to Jun 2018 was retrospectively reviewed. 108 cases with RLNIZ lymph node dissection for pathological examination were included. The relationship between metastasis of RLNIZ lymph node and clinicopathologic characteristics was analyzed.Results:RLNIZ lymph node was detected in 12.3%(91/738)cases, the mean lymph node number in RLNIZ was 1.5±0.7, and 30.8%(28/91) cases suffered RLNIZ lymph node metastasis. RLNIZ lymph node metastasis(LNM) is associated with tumor size( P=0.028), capsular invasion( P=0.019), No. of central compartment LNM( P<0.001) and lateral neck LNM( P<0.001). No. of central compartment LNM was found to be the independent risk factor of RLNIZ lymph node metastasis. The incidence of dysphagia and inferior parathyroid damage was 0.9%(1/108)respectively. Conclusions:RLNIZ lymph node metastasis is common among PTC patients , therefore, RLNIZ lymph node should be routinely removed especially in patients with tumor size over 1cm、suspected capsular invasion and lateral neck lymph node metastasis confirmed by preoperative imaging examination.

Study on expression of IL-13 and correlation between IL-13 and MUC5AC in eosinophilic chronic rhinosinusitis with nasal polyps / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore expression of IL-13 in eosinophilic chronic rhinosinusitis with nasal polyps(EOS-CRSwNP) and further investigate the correlation between IL-13 and MUC5AC in EOS-CRSwNP. METHODS MUC5AC was detected in tissues from normal nasal mucosa and EOS-CRSwNP by immunohistochemistry and ELISA. We also used ELISA to detect the expression of IL-13 in normal nasal mucosa and EOS-CRSwNP. Correlation between IL-13 and MUC5AC in EOS-CRSwNP was investigated by correlation analysis. Secretion of MUC5AC in IL-13 incubated primary air-liquid interface(ALI)-cultured nasal polyp epithelial cells was examined by ELISA. RESULTS MUC5AC is mainly expressed in the epithelium of nasal mucosa by immunohistochemistry. By ELISA, expressions of MUC5AC and IL-13 are higher in EOS-CRSwNP than those in normal nasal mucosa. Correlation analysis shows that there exists a high correlation between MUC5AC and IL-13 in EOS-CRSwNP. IL-13 upregulates expression of MUC5AC in IL-13 incubated primary ALI-cultured nasal polyp epithelial cells for 7 or 14 days. CONCLUSION Expressions of MUC5AC and IL-13 are higher in EOS-CRSwNP than those in normal nasal mucosa respectively, and MUC5AC correlates with IL-13 highly in EOS-CRSwNP.

Clinical significance of lymphatic metastasis between sternocleidomastoid and sternohyoid muscle in papillary thyroid cancer / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical significance of metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC).@*Methods@#A total of 175 patients with PTC who underwent thyroidectomy with LNSS dissection were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors for LNSS metastasis in PTC.@*Results@#The rate of detectable LNSS was 70.9% (124/175) and metastasis rate was 7.4% (13/175). Of 13 cases with LNSS metastasis, 10 with the coexistence of cervical lymph node metastasis. Univariate Logistic regression analysis showed that multiple focal cancer, tumor located in the lower pole of thyroid, belt-shaped muscle invasion, lateral cervical lymph node metastasis, cN+ , the number of cervical lymph nodes with metastasis and the number of lymph nodes with metastasis in level Ⅳwere the risk factors for LNSS metastasis (P<0.05). Multivariate Logistic regression analysis suggested that tumor located in the lower pole of thyroid and the number of cervical lymph nodes with metastasis >6 were the independent risk factors for LNSS metastasis (P<0.05). Given the number of cervical lymph nodes with metastasis as a predictor for the LNSS metastasis, the sensitivity was 92.3%, the specificity was 66.7% and the accuracy rate was 68.6%.@*Conclusions@#LNSS metastasis is commom in PTC, with a metastasis rate of 7.4%. PTC in the lower pole of thyroid and the number of cervical lymph nodes with metastasis > 6 are independent risks for LNSS metastasis.

The diagnosis and treatment of one huge cystic lymphangioma in etropharyngeal space / 临床耳鼻咽喉头颈外科杂志

One child was hospitalized because of repeated cough and sputum. The biopsy diagnosis in local hospital was cystic lymphangioma in retropharyngeal space. We carried out transoral incision and drainage by catheter under general anesthesia. Put into the surgical cavity a suction drainage tube, and injected 5 mg dexamethasone and 8mg Bleomycin. He had nasogastric liquid diet after operation. We removed the suction drainage tube two weeks later. No recurrence was found following up over two years.

Application of bronchofiberscopy laryngeal mask coupled with foreign body forceps in the removal of children airway foreign bodies / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the value of bronchofiberscopy laryngeal mask airway coupled with foreign body forceps in the removal of children airway foreign bodies.</p><p><b>METHODS</b>Bronchofiberscopy laryngeal mask airway and its mating foreign body forceps were designed. Ninety-two children with airway foreign bodies were hospitalized from Jan. 2011 to Oct. 2013 underwent removal surgeries through bronchofiberscopy via laryngeal mask airway coupled with the mating foreign body forceps under fast induction general anesthesia. The fluctuation of the patients' blood pressure (BP), heart rate (HR), saturation of pulse oxygen (SpO2) and pressure of end-tidal carbon dioxide (PetCO2) were recorded. SPSS 13.0 software was used to analyze the data.</p><p><b>RESULTS</b>All the operations were successful, and the haemodynamics indexes of the patients were stable with good ventilation. No side effect and complications were found. Compared with the basic value before anesthesia, there was no statistically significant difference in pulse blood pressure PetCO2 between immediately after laryngeal mask, laryngeal mask after 3 minutes, bronchoscope into the glottis instantly, immediately after laryngeal mask. SpO2 increased after laryngeal mask (F = 3.04, P < 0.05).</p><p><b>CONCLUSION</b>Bronchofiberscopy laryngeal mask airway coupled with foreign body forceps applied in the removal surgery of children airway foreign body is safe, effective and with less complication.</p>

Application experience of endoscopic treating sinus bone fibrous dysplasia under navigation guidance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Research for surgical methods and experience of sinus fibrous dysplasia treatment by auxiliary nasal endoscopy image navigation.@*METHOD@#Retrospective analysis of the records of 4 patients from March 2006 to December 2011 who were diagnosed as fibrous dysplasia of nasal sinuses, 2 male and 2 female, aged from 19 yrs to 55 yrs and average age was 38 yrs; 3 of them were destroyed of sinus floor, the other who had the bone fiber of sphenoidal sinus. By using 16 multi slice spiral CT and 3D reconstruction, the 4 cases were all treated by drill grinding abnormal fibrous tissue in the nasal sinus cavities with auxiliary nasal endoscopy image navigation, to achieve contour in the bone fiber cavities.@*RESULT@#Lesions of 4 cases were accurately found and grinded under auxiliary nasal endoscopy image navigation. For 3 patients, headache, nasal congestion, facial discomfort and other symptoms have gradually disappeared after operation. However, one patient with sinus floor destroyed suffered facial swelling and pain 3 month after operation, with ineffective conservation treatment outcomes. After CT re-scan, it showed that there were a large number of bone residue in maxillary sinus during the re-operation. The reason was that the surgical cavity was not rinsed off which leaded to maxillary sinus congestion. With the methods of expansion of the maxillary sinus, flushing the cavity, and postoperative nasal and maxillary sinus rinse, symptoms disappeared 1 month later without recurrence.@*CONCLUSION@#Patients with fibrous dysplasia of nasal sinuses are treated thoroughly, securely, and effectually, by drill grinding abnormal fibrous tissue in the nasal sinus cavities with auxiliary nasal endoscopy image navigation, to achieve contour in the bone fiber cavities.

Application of image guidance system in endoscopic optic nerve decompression of traumatic occlusion optic neuropathy affiliated with cerebrospinal rhinorrhea / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the advantages of image guidance system in endoscopic optic nerve decompression of traumatic occlusion optic neuropathy affiliated with cerebrospinal rhinorrhea.@*METHOD@#Retrospective review of 15 traumatic occlusion optic neuropathy affiliated with cerebrospinal rhinorrhea at our department between June 2006 and June 2010. Witch were performed endoscopic optic nerve decompression and cerebrospinal rhinorrhea euplastic by image guidance system.@*RESULT@#After 3 months to 1 year follow-up, All the cases with cerebrospinal rhinorrhea euplastic were successful. Two cases recovered to 0.3-0.6 in visual activity. Two cases to 0.1-0.3. One case was less than 0.1. Two cases could see hand movement and 2 cases had light perception. Total effective rate was 60 percent (9/15).@*CONCLUSION@#Image guidance system combined with endoscopy provides accurate localization and identifies the operative borders and critical anatomical structure of skull base, optic nerve and internal carotid artery,and also clearly indicate their adjacent relations,also decreases surgical invasions and complications. Image guidance system can improve the accuracy and safety, particularly in local anatomic structure due to the trauma caused by changes in the relationship. It is a safety and effective therapy method.