ABSTRACT
Objective To study the effect of menopause status and the time of taking tamoxifen (TAM) on endometrial lesions after breast cancer surgery. Methods A total of 330 patients with postoperative vaginal irregular bleeding after breast cancer surgery or endometrial lesions after B ultrasonic from August 2007 to August 2017 in Northern Jiangsu People 's Hospital were retrospectively analyzed, including 180 cases of taking TAM treatment (medicine-taking group), and 150 cases of not taking TAM treatment (non medicine-taking group). The patients were also divided into the menopause group and the premenopausal group. According to the time of taking TAM, the patients were divided into < 2 years group, 2-5 years group and > 5 years group. Chi-square and Fisher test were used to compare the differences. Results The endometrial lesions incidence in the medicine-taking group was higher than that in the non medicine-taking group [84.44 ％ (152/180) vs. 56.00％(84/150);χ2=51.701, P=0.000]. The endometrial lesions rate in the menopause group was higher than that in the premenopause group [medicine-taking group: 69.70 ％ (46/66) vs. 92.98 ％ (106/114), χ2= 17.254, P= 0.000; non medicine-taking group: 46.15 ％ (35/65) vs. 63.53 ％(54/85), χ2 = 4.513, P= 0.034]. For the patients in the menopause group and the premenopause group, the incidence of endometrial lesions for those who took medicine for>5 years [96.00％(48/50), 85.19％(23/27)] was higher than that in the<2 years group and 2-5 years group [78.26％(18/23), 42.86％(6/14);95.12％(39/41), 72.00％(18/25) respectively], and there were statistical differences (χ2=7.619, P=0.022;χ2= 8.070, P= 0.018). The menopause was not correlated with staging, muscular lawyer infiltration and lymph metastasis postoperative (P> 0.05), but with the type of endometrial cancer (P= 0.013); the length of taking medicine was related with the type of endometrial cancer and the lymph metastasis (P=0.027). With the prolonged time of medicine-taking for postmenopause patients, the incidence of type Ⅱendometrial cancer and positive rate of lymph metastasis were also increased. Conclusions Taking TAM after surgery for breast cancer patients increases the risk of endometrial lesions. The longer the patients take the medicine, the greater risk of the lesions take, and the worse the pathological, histological type and prognosis of endometrial carcinoma are, which is more obvious for postmenopausal women who take TAM for more than 5 years.
ABSTRACT
Objective To analyze the anatomical relationship between Zuckerkandl's tubercle (ZT) and the recurrent laryngeal nerve(RLN),to reduce the incidence of RLN injury risk.Methods 280 patients undergoing total thyroidectomy from Jan.2008 to Jan.2013 were included in our study.A meticulous technipue of excapsular dissection was used to dissect thyroid.ZT's size,classification,and its relationship with RLN were studied and classified.Results A total of 280 thyroid gland lobes were dissected.ZT identified in the left was 94.1％(128/136),right 96.4％(160/166),and bilateral 72.8％(220/302).ZT grades were as the following:Grade 0,left 11.8％(16/136) and right 11.4％(19/166);Grade I,left 30.1％(41/136) and right 25.3％(42/166);Grade II,left 44.1％(60/136) and right 43.4％(72/166);Grade III,left 8.1％(11/136) and right 16.3％(27/166).There was no significant difference on ZT classification between the left side and right side.For ZT with grade I or above,112 cases were at the left side,among which type A was 90.2％(101/112),type B 0.9％(1/112),type C 7.1％(8/112),and type D 1.8％(2/112),and 141 cases were at the right side,among which type A was 92.9 ％ (131/141),type B 0.7％(1/141),type C 5.0％(7/141),and type D 1.4％(2/141).There was no significant difference between the left side and the right side in terms of type.Type A of ZT was the most common type.Conclusion As an important anatomic landmark,ZT is essential for locating and dissecting RLN during thyroid surgery,however,due to its complex anatomical relationship with adjacent organs and the variability of RLN and its branches here,from which to reveal RLN has the possibility of increasing the injury risk.