Value of jugulo-omohyoid lymph nodes in predicting lateral cervical occult metastasis in patients with papillary thyroid carcinoma / 中华肿瘤杂志

Objective@#To investigate the value of jugulo-omohyoid lymph nodes (JOHLN) in predicting occult lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC).@*Methods@#The clinicopathological data of 136 out of 2 100 PTC patients, who had a high risk of lateral neck lymph node metastasis and treated by us from January 2010 to December 2015, were retrospectively analyzed. Super selective neck dissection (SSND, level Ⅲ and Ⅳ)was performed and JOHLNs were sent for frozen section in all the 136 cases. The clinicopathological data was analyzed and the significance of JOHLN in predicting lateral cervical LNM was calculated using the SPSS software package.@*Results@#Of the 136 patients, total thyroidectomy was performed in 76 cases (55.9%) and unilateral lobectomy plus isthmus was performed in the other 60 cases (44.1%). SSND was performed in 72 patients (52.9%), level Ⅱ-Ⅳ dissection in 15 (11.0%), and level Ⅱ-Ⅴ dissection in 49 (36.0%). According to the pathological results, 38 patients were pN0(27.9%), 18 (13.2%) were pN1a and 80 (58.8%) were pN1b. The lymph node metastasis(LNM) rates at level Ⅱ-Ⅵ were 19.9%, 43.4%, 42.6%, 2.9%, and 59.6%, respectively. The sensitivity, specificity and accuracy of JOHLN in predicting lateral neck metastasis were 58.8%, 62.9%, and 76.7%, respectively. The rates for predicting level Ⅱ metastasis were 81.5%, 43.2%, and 59.4%, respectively. None of the patients died in the follow-up. Only 1 recurrence was found in level Ⅱ and regional control was achieved after level Ⅱ and Ⅴ dissection.@*Conclusions@#JOHLN has a high accuracy for predicting lateral cervical lymph node metastasis and high sensitivity for level Ⅱ metastasis. For patients with high risk of lateral cervival metastasis, super-selective neck dissection including level Ⅲ and Ⅳ can confirm the stage and reduce the risk of reoperation. Dissection for level Ⅱ, Ⅲ, and Ⅳ is recommended.

Analysis of risk factors for bleeding after thyroid surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To identify risk factors for bleeding after thyroid surgery, and discuss the potential relevance between the bleeding timing and sources.</p><p><b>METHODS</b>A total of 2568 cases that underwent thyroid operation from June 2012 to June 2013 were collected and analysed retrospectively the risk factors for postoperative bleeding by Cox and the potential relevance between the bleeding timing and sources.</p><p><b>RESULTS</b>Among 2568 patients, 40 patients occurred postoperative bleeding Indentified risk factors were extent resection (P=0.0435) and surgeon (P=0.0071). Thyroid bed and strap muscles/sternocleidomastoid were the most common sources of bleeding after surgery within 6 hours; while thyroid bed was the most common source of bleeding after surgery between 6 and 8 h; wound errhysis was the most common source during 8-24 h after the operation; thyroid bed and strap muscles/sternocleidomastoid were the most common sources within 24 h after thgroid surgery.</p><p><b>CONCLUSIONS</b>Bleeding after thyroid surgery is a rare but potentially life-threatening complication, and the extent of resection and the surgeon are risk factors. Thyroid bed and strap muscles/sternocleidomastoid are the most common sources of bleeding after surgery within 24 hours.</p>

Digital and three-demention print technique in reconstruction for complex defect after resection of jaw neoplasms / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the application of digital and three-demention (3D) print technique in reconstruction of complex jaw defect after removal of maxillofacial cancer.</p><p><b>METHODS</b>From May 2013 to January 2015, 10 cases were enrolled in the study, 3 were maxillary defects and 7 were mandibular defects. The process included preoperative computer aided design, template and model manufacture with 3D Printer, intraoperative ablation and shaping of fibula based on template, flap suture and vessel anastomosis.</p><p><b>RESULTS</b>All the cases were successfully operated according to preoperative computer aided design, and all the fibulas and skin islands survived. All the cases had regular diet 2 weeks after surgery and showed satisfying appearance.</p><p><b>CONCLUSION</b>Digital and 3D print technique has good practicability in reconstruction of complex jaw defect with free fibula.</p>

Free jejunum for circumferential hypopharynx and cervical esophagus reconstruction / 中华胃肠外科杂志

Free jejunum has always been a good choice for circumferential hypopharynx and cervical esophagus reconstruction with a low complication rate. Although more and more flaps were used in recent years, free jejunum is still considered as the first choice for such defect.

Diagnosis and treatment of chylothorax after neck dissection / 中国耳鼻咽喉头颈外科

1000 ml per day had to be cured by operation.

Transmaxillary approach for surgical removal of the invasive skull base tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the capable use of transmaxillary approach for surgical removal of invasive skull base tumors, the indications and the key points of this approach.</p><p><b>METHODS</b>From November 1998 to July 2001, 27 consecutive patients with skull base tumor were operated through transmaxillary approach, including 6 patients with nasopharyngeal carcinoma, 5 with nasopharyngeal angiofibroma, 5 with nasopharyngeal cystadenocarcinoma, 2 with olfactory neuroblastoma, 2 with poorly differentiated carcinoma, 2 with sarcoma, 1 with maxillary carcinoma, 2 with schwannoma, and 2 with chordoma. Most of them (18/27) were recurrent tumor and 17/27 tumors involved important intracranial structures. All patients were followed up 2 - 33 months (average 16 months) and the clinical data was reviewed.</p><p><b>RESULTS</b>The tumors could be totally removed in all patients. There were no operative mortality and morbidity. After operation, 2 patients died of cancer recurrence in 5 and 8 months separately. One patient had metastasis to the lungs 11 months after operation. Two patients had local recurrence in 7 and 12 months postoperation seperately and live with the tumor now. The rest patients are back to their routine life.</p><p><b>CONCLUSIONS</b>Transmaxillary approach facilitates the surgical removal of invasive skull base tumors. The exposure is wide. The lesion as well as the important anatomy structures can be viewed directly and clearly. The tumor removal could be done more thoroughly and safely. This approach is suitable for the patients in whom tumor involves the skull base extensively and may be difficult to deal with by other approaches.</p>