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Objective:To observe the application of near-infrared autofluorescence imaging (NIRAF) technology combined with carbon nanoparticle (CNP) negative imaging in identification of parathyroid gland (PG) during thyroid carcinoma surgery.Methods:80 patients with thyroid cancer who underwent total thyroidectomy + central lymph node dissection performed by the same experienced physician team at the 960th Hospital of the PLA from Jan. to Mar. 2022 were prospectively included. Before operation, they were divided into two groups using random number table method before surgery: control group (40 cases) using CNP negative imaging, and experimental group (40 cases) using CNP negative imaging combined with NIRAF technique for intraoperative identification of PG. The gold standard for the identification of parathyroid glands was to compare the amount of intraoperative discovery retention misresection and transplantation of PG and the number of postoperative parathyroid hormone (PTH) and the number of complications in the two groups by immune colloidal gold technique. SPSS 25.0 software was used for statistical analysis.Results:All patients in the two groups were successfully operated and followed up. 137 149 PG were found and confirmed in the control group and the observation group, 108 132 PG were retained in situ and 29 17 PG were transplanted, the differences were statistically significant (all P <0.05) ; The number of A1 PG was 103 and 109, respectively. Among them, 84 102 were retained in situ and 19 7 were transplanted, the difference was statistically significant ( P <0.05) . There was no significant difference in the amount of A2 type PG and B type PG between the two groups ( P >0.05) . No A3 type PG was found in the two groups, and a total of 3 A3 types of PG were confirmed in postoperative pathological reports. There were no significant differences in misresection in the control group and the observation group, 5 and 2 PG were mistakenly cut, respectively (all P >0.05) . The PTH 1 day after surgery was 17.7 (5.6,30.4) pg/mL in the control group and 21.7 (12.8,38.3) pg/mL in the observation group, the difference was statistically significant ( P<0.05) . There were no significant differences in the levels of serum calcium and serum phosphorus 1 day after operation and PTH 1 month after surgery between the two groups (all P > 0.05) . Conclusion:Compared with CNP alone, combined with NIRAF technique can quickly and effectively identify PG, and PG can be better protected in situ and postoperative hypoparathyroidism can be reduced.
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Objective:To discuss the long-term survival and risk factors of thyroid cancer in the real world in China.Methods:The clinical data of thyroid cancer patients who underwent initial surgery from Apr. 1998 to Dec. 2018 were retrospectively analyzed, including patients’sex, age, surgical records, pathology, hospitalization records and follow-up. According to the prognosis, the patients were divided into disease-free survival group and recurrence/metastasis/death group. Univariate analysis and multivariate regression analysis were conducted to analyze the risk factors affecting the prognosis of thyroid cancer. The clinical features and prognostic risk factors of thyroid cancer patients were investigated.Results:A total of 2038 cases were collected, and the longest follow-up time was more than 20 years. A total of 1876 cases were included in the study, 162 cases were lost, and the rate of follow-up was 7.9%. Among them, 1858 survived, the overall survival rate was 99.04%; 18 died, and the overall mortality rate was 0.96%. According to the prognosis of thyroid cancer, the patients were divided into 2 groups, including 1808 cases in the disease-free survival group and 68 cases in the relapsed-metastatic-death group. The study found that there were statistical differences between the two groups in terms of patients’age [ (45.40±11.016) vs (51.53±15.199, P=0.000) , the male ratio (32.854%, 48.529%, P=0.001) , whether tumor breaks through capsule (20.077%, 33.823%, P=0.006) , central lymph node metastasis (48.834%, 70.588%, P=0.001) and lateral lymph node metastasis (31.084%, 55.882%, P=0.000) , and there was no difference between the number of tumor lesions. Conclusion:Thyroid cancer has a good prognosis, but according to the characteristics of patients with thyroid cancer in my country, it should still be treated early in the clinic, and the standardization and thoroughness of surgery should be adhered to during the treatment.
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Objective:To investigate the safety and efficacy of da Vinci surgical system in surgical treatment of primary hyperparathyroidism.Methods:The clinical data of 19 patients with primary hyperparathyroidism who received the Da Vinci robot surgical system (the da Vinci surgery group) from Feb. 2016 to May. 2020 and 23 patients undergoing open parathyroid surgery (the open surgery group) were retrospectively analyzed and compared. The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, postoperative serum calcium and phosphorus, parathyroid hormone, postoperative pain visual analog score, and surgical complications rate and beauty effect of the two groups were statistically compared. The postoperative clinical symptoms and recurrence were followed up in a duration 3 to 84 months.Results:All patients completed the operation successfully, there was no conversion to open operation in the da Vinci surgery group. The operation time (65.5±9.9 vs 54.3±8.3) min ( t=6.231, P=0.015) and postoperative drainage volume (109.7±50.6 vs 97.2±45.2) ml ( t=3.132, P=0.016) in the da Vinci surgery group were more than those in the open surgery group, while the cosmetic effect (9.1±0.6 vs 8.3±0.7) ( t=3.628, P=0.031) was better in the da Vinci surgery group than in the open surgery group. There was no significant difference in intraoperative blood loss (44.3±19.4 vs 39.1±15.4) ml, hospital stay (7.4±1.4 vs 7.9±2.8) days, incidence of complications (15.8% vs 8.7%) , visual analogue scale of postoperative pain (6.9±0.6 vs 6.4±0.8) , clinical symptom relief during the follow-up (100.0% vs 100.0%) , postoperative serum calcium (2.48±0.30 vs 2.43±0.26) mmol/L, serum phosphorus (0.75±0.07 vs 1.37±0.31) mmol/L or parathyroid hormone (36.5±4.7 vs 40.4±5.3) ng/L between the da Vinci surgery group and the open surgery group ( P>0.05) . Conclusion:Leonardo da Vinci robot-assisted surgical treatment for primary hyperparathyroidism with strict surgical indications is similar to traditional open surgery in safety and efficacy, while its cosmetic effect is better.
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Objective:To evaluate the feasibility and safety of robotic thyroidectomy for treatment of thyroid benign tumor with diameter larger than 5cm.Methods:The clinical data of 36 patients (in the robot group) who received Da Vinci robot thyroid benign tumor surgery in the thyroid breast Surgery Department of the 960th Hospital of the PLA (Former Jinan Military General Hospital of PLA) from Jan. 2014 to Jun. 2019 were retrospectively analyzed, and compared with 48 patients (in the open group) who received open surgery in the same period.The operative time, intraoperative blood loss, length of hospital stay, postoperative drainage volume, postoperative parathyroid hormone, cosmetic effect, incidence of surgical complications and postoperative recurrence rate of the two groups were observed. Statistical software SPSS16.0 was used for statistical analysis of the data.Results:Both groups successfully completed the operation. Compared with the open group, the operation time ( t=11.232, P<0.001) and postoperative drainage volume ( t=2.892, P=0.003) of the robot group were more than those of the open group, and the aesthetic effect was better ( t=3.291, P=0.024). Intraoperative blood loss ( t=1.575 , P=0.118), hospital stay ( t=-1.784, P=0.091), postoperative PTH ( t=1.892, P=0.086), incidence of surgical complications ( χ2=3.291, P=0.610), visual analogue score of postoperative pain ( t=-2.431, P=0.081) and postoperative recurrence rate were not significantly different ( P>0.05). No recurrence occurred during follow-up. Conclusion:For patients with a selective benign thyroid tumor with a diameter of 5-8 cm, the bilateral axillo-breast and transaxillary approach for thyroid surgery by Da Vinci robot are safe, effective and have better cosmetic results.
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Objective@#To investigate the surgical treatment strategies for persistent and recurrent parathyroidectomy after total parathyroidectomy plus autotransplantation(tPTX+ AT) in cases of renal hyperparathyroidism.@*Methods@#From Oct 2009 to Oct 2018, 480 patients with renal hyperparathyroidism received tPTX+ AT in our hospital. 32 patients suffered from post-op persistent (31) and recurrent (1) hyperparathyroidism .The high frequency ultrasonography combined with fine needle puncture eluent PTH determination and SPECT/CT co-computed tomography fusion imaging were used as qualitative and localizing diagnostic methods before reoperation.@*Results@#Of the 32 patients, 28 cases underwent reoperation for once, and 4 underwent reoperations fort wice. 36 parathyroid glands and 2 grafts were resected.In 31 patients the bone pain, skin pruritus relieved significantly or disappeared, and muscle strength gradually increased compared with that before operation. Level of iPTH in 31 patients fluctuated between 15 and 90 ng/L. Postoperative parathyroid hormone decreased compared with that before the operation (P<0.05). One patient was still with persistent hyperparathyroidism despite reoperation, whose iPTH fluctuated between 550 and 1 000 ng/L during 6 months to 2 years follow-up.@*Conclusion@#Ultrasonography, FNA-iPTH and SPECT/CT co-computed tomography can be used as methods for qualitative and localizing diagnosis of PTPT or PHPT.With accurate preoperative localization, resection of all parathyroid glands is an effective treatment for posto perative persistent and recurrent renal hyper parathyroidism.
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Objective To investigate the surgical treatment strategies for persistent and recurrent parathyroidectomy after total parathyroidectomy plus autotransplantation (tPTX + AT) in cases of renal hyperparathyroidism.Methods From Oct 2009 to Oct 2018,480 patients with renal hyperparathyroidism received tPTX + AT in our hospital.32 patients suffered from post-op persistent (31) and recurrent (1) hyperparathyroidism.The high frequency ultrasonography combined with fine needle puncture eluent PTH determination and SPECT/CT co-computed tomography fusion imaging were used as qualitative and localizing diagnostic methods before reoperation.Results Of the 32 patients,28 cases underwent reoperation for once,and 4 underwent reoperations fort wice.36 parathyroid glands and 2 grafts were resected.In 31 patients the bone pain,skin pruritus relieved significantly or disappeared,and muscle strength gradually increased compared with that before operation.Level of iPTH in 31 patients fluctuated between 15 and 90 ng/L.Postoperative parathyroid hormone decreased compared with that before the operation (P ＜ 0.05).One patient was still with persistent hyperparathyroidism despite reoperation,whose iPTH fluctuated between 550 and 1 000 ng/L during 6 months to 2 years follow-up.Conclusion Ultrasonography,FNA-iPTH and SPECT/CT co-computed tomography can be used as methods for qualitative and localizing diagnosis of PTPT or PHPT.With accurate preoperative localization,resection of all parathyroid glands is an effective treatment for postoperative persistent and recurrent renal hyper parathyroidism.
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Objective To detect the influence of the first operation standardized or not on reoperation for differentiated thyroid carcinoma.Methods Retrospective analysis was conducted of the clinical data of 217 reoperation case of differentiated thyroid carcinoma from May 2009 to March 2018 in the 960th Hospital of the PLA Joint Logistic Support Force,including 58 male cases and 159 female cases,with the average age of 46.65 years (range from 19 to 76).According to the first operation standardized or not,all patientswas divided into standardized group (n =114) and non-standard group (n =103).Between the two groups,the number of dissected and metastatic lymph nodes,tumor pathology,recurrence range of glandular and central lymph nodes,number of lymph nodes removed and transferred,operation and drainage time,tumor invaded surrounding tissues,invasion sites,and complications were conducted.Results The overall gland recurrence rate was 20.2％ of 217 cases (44/217),8.8％ (10/114) in the standardized group and 33％ (34/103)in the non-standard group.The central group had a total recurrence rate of 38.7％ (84/217),and the standardized group and non-standard group were 22.8％ (26/114) and 56.3 ％ (58/103),respectively.For patients,the total cervical lymph node recurrence rate was 74.7％ (162/217),and the standardized group and non-standard group were 87.7％ (100/114),and 60.3％ (62/103),respectively.All of the difference was statistically significant(P =0.000,P =0.000,P =0.000).The operation time and drainage time of the standardized surgery group were significantly shorter than the non-standard group[(2.52±0.80)h vs(3.14±0.83) h,P=0.000;(4.37±1.28)d vs (5.16±1.41)d,P=0.000].Conclusions For differentiated thyroid carcinoma,the nonstandard treatment significantly affected the tumor residual rate in gland and lymph node metastasis rate of reoperation,andstandardized surgical treatmentshould be advocated.
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Objective To evaluate the clinical safety and effectiveness of da Vinci Si surgical system in total parathyroidectomy with autotransplantation of secondary hyperparathyroidism.Methods A retrospective analysis was conducted with da Vinci Si surgical system on 16 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Mar 2014 to June 2016.The changes of clinical symptoms,parathyroid hormone,calcium and phosphate blood levels were followed up from 6 months to 2 years.Results Surgery was successful in all 16 cases and 62 parathyroid glands were resected.There were no operation-related complications and no conversions to open or endoscopic surgery.Mean operation time was (136 ± 24) minutes.In all postoperative cases the musculoskeletal pain,skin itching were relieved or disappeared.PTH,calcium and phosphate blood levels decreased and no recurrence during follow-up period,The postoperative cosmetic result was satisfatory.Conclusions Da Vinci Si surgical system used in the parathyroid surgery is safe and effective,especially suitable for patients with cosmetic requirements.
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Objective To evaluate the clinical safety and effectiveness of total parathyroidectomy with autotransplantation on the chronic renal failure (CRF) patients who are suffering from severe secondary hyperparathyroidism (SHPT).Methods A retrospective analysis was performed on 149 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Apr.2010 to Oct.2015.The changes of clinical symptoms,parathyroid hormone,calcium and phosphate blood levels were followed up during 6 months to 6 years.Results 598 parathyroid glands were obtained form 149 patients who underwent surgical resection.Musculoskeletal pain and skin itching relieved or disappeared in 145 cases the 2nd day after operation,while these symptoms gradually relieved one week after operation for 4 cases.Serum intact parathyroid hormone (iPTH)was 89.67±180.61,serum phosphate 1.74±0.52,and serum calcium 2.07±0.32 the 1st day after operation,and they all decreased compared with those before operation(P＜0.001).Serum calcium,phosphorus and iPTH levels were similar at 6,36 and 60 months after operation (P＞0.05).Two patients had pathological fracture after operation.No persistent bone pain or skin itching was found during the follow-up period.Two patients had secondary hyperparathyroidism.Six patients had recurrence,among whom five underwent surgery again,and one patient had clinical follow-up.One patient died of pulmonary infection at 13 months after operation.Conclusion Total parathyroidectomy with autotransplantation were applied to ineffective medical treatment for advanced secondary hyperparathyroidism in patients with chronic renal failure.
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Tertiary hyperparathyroidism is commonly observed in patients with long-standing chronic kidney disease (CKD) after renal transplantation and is characterized by the autonomous hypersecretion of PTH leading to hypercalcemia.The primary treatment is surgery.After the introduction of cinacalcet,both surgical and medical methods have been commonly performed to treat tertiary hyperparathyroidism.However,which treatment is more appropriate has not been fully demonstrated.In this paper,the author will systematically review the related research of surgical treatment and cinacalcet in the treatment of 3HPT,and summarize their respective therapeutic effects.
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Objective To evaluate the safety and feasibility of INTRABEAM in breast conserving surgery for early stage breast cancer.Methods Clinical data of 43 cases of early breast cancer undergoing INTRA-BEAM intraopetative radiotherapy from Jan.2013 to Dec.2014 were retrospectively analyzed.All cases underwent breast conserving surgery combined with 20 Gy INTRABEAM intraoperative radiotherapy.The postoperative incision,incidence of local complications and acute radiation injury were recorded after surgery.Breast recovery,the cosmetic effects,early overall survival,recurrence-free survival,and non-metastatic survival were followed up.Results All cases were given breast conserving surgery associated with INTRABEAM intraoperative radiotherapy (20 Gy),with median radiotherapy time of 31 mins ranging from 25 to 39 mins.Five cases underwent postoperative whole breast irradiation.Major early complications included incision infection (1 case),postoperative effusion (5 cases),radiation area skin pain (4 cases).The short-term follow-up survey showed that the satisfaction rate was 93.0％.The overall survival rate,recurrence free survival rate and metastasis free survival rate was 100％ respec tively.Conclusion Breast conseving surgery combined with INTRABEAM intraoperative radiotherapy for early breast cancer patients is safe and feasible.
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Robotic thyroidectomy (RT) system combines the advantages of the surgical robot and remote access thyroidectomy,provides the benefits of excellent three-dimensional visualization,stable operative view and improved surgical dexterity,has been applied in clinical practices for 10 years and proved to have comparable surgical safety and oncological completeness with traditional open operation,and provides smaller surgical injury (psychological and physical injury),better functional protection (including neck function,parathyroid glands and laryngeal nerve),and significantly higher cosmetic satisfaction.There are two mostly common used RT approaches,bilateral axillobreast approach (BABA) and transaxillary approach (TAA).Since surgeons accumulate more experience,the indications of RT have been expanded to differentiated thyroid cancer with tumor size between 2-4 cm with (or without) lateral neck lymph node metastases by far.To date,all related studies are nonrandomized or retrospective comparisons.It's necessary to launch multi-centers randomized studies and long term follow-up to offer higher evidence to boost the future application of RT.
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Objective To explore the diagnostic value in fine needle aspiration cytology combined with thyroghobulin measurement of suspected malignant cervical enlarged lymph node in differentiated thyroid carcinoma.Methods The study included 82 patients with differentiated thyroid carcinoma who were found suspected metastatic lymph nodes in neck during follow-up and accepted reoperation from January 2015 to May 2017.Ultrasound-guided fine-needle aspiration was done in 130 suspected malignant lymph nodes,at the same time,thyroghobulin in fine needle aspiration cytology washout fliud was measured with electrochemiluminescence,fine needle aspiration cytology combined with thymglobulin measurement in fine-needle aspiration biopsy.All suspicious malignant lymph nodes were precise positioning preoperative by injection of mnocarbon suspension under guidence of ultrasound.The analyze was performed according to the final pathological diagnosis after operation.The sensitivity,specificity and accuracy of fine needle aspiration cytology,thymglobulin measurement in fine-needle aspiration biopsy,fine needle aspiration cytology and thyroglobulin measurement in fine-needle aspiration biopsy were calculated by Fomage's statistical method and x2 test was used for comparison among groups.Results Eighty-two patients with 130 lymph nodes with definitemarkers and pathological diagnosis,with a pathological examination of 119 and negative 11 cases.The sensitivity of fine needle aspiration cytology,thyroglobulin measurement in fine-needle aspiration biopsy,fine needle aspiration cytology and thyroglobulin measurement in fine-needle aspiration biopsy was 88.2％,94.1％ and 95.8％,with specificity of 54.5％,72.7％ and 81.8％,with accuracy of 85.4％,92.3％ and 94.6％.Conclusion The sensitivity,specificity and accuracy of fine needle aspiration cytology combined thyroglobulin measurement in fine-needle aspiration biopsy were higher than that of fine needle aspiration cytology or thyroglobulin measurement in fine-needle aspiration biopsy alone,which can be used as a method of qualitative diagnosis during differentiated thyroid cancer postoperative follow-up.
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<p><b>OBJECTIVE</b>To evaluate surgical outcomes and the feasibility of robotic thyroidectomy and central neck dissection (CND).</p><p><b>METHODS</b>The clinical data of 40 patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND using the Da Vinci system through axillo-bilateral-breast approach in Jinan Military General Hospital of People's Liberation Army from February to December 2014 were analyzed retrospectively (robotic group). Other forty patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND by open approach were selected as the control (open group). Cosmetic satisfaction was assessed after a month postoperation by the numerical score system. t-test and χ(2) test were used to compare the clinical characters, total operative time, intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, visual analogue scale for pain, postoperative complications, and cosmetic effect between the 2 groups.</p><p><b>RESULTS</b>All 80 patients were diagnosed of papillary thyroid microcarcinoma. The total thyroidectomy (or lobectomy/isthmusectomy) with CND of 40 patients were successfully performed by da Vinci Si surgical system. The numbers of total thyroidectomy of robotic group and the open group were 36 and 37, respectively. The numbers of metastatic lymph nodes of robotic group and open group were 14 and 15, respectively. The operation time of the robotic group was (130±12) minutes, which was longer than that of open group (98±11) minutes (t=12.432, P<0.05). The study showed statistical significant difference between the two groups regarding the visual analog scale pain assessment (1.9±0.9 vs.3.9±1.1, t=8.900, P<0.05). There were no statistical significant difference of intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, and the complication rate between the 2 groups.Postoperative cosmetic result was more satisfying on the robotic group (9.1±0.5) than open group (4.8±1.5) (t=17.200, P<0.05).</p><p><b>CONCLUSIONS</b>The robotic total thyroidectomy (or lobectomy and isthmusectomy) and CND has similar surgery safety and feasibility as open procedures. The robotic thyroidectomy is a good alternative surgical modality for patients with papillary thyroid microcarcinoma who wish to avoid neck scars.</p>
Subject(s)
Humans , Axilla , Breast , Carcinoma, Papillary , General Surgery , Length of Stay , Lymph Nodes , Neck Dissection , Operative Time , Postoperative Complications , Postoperative Period , Retrospective Studies , Robotic Surgical Procedures , Thyroid Neoplasms , General Surgery , Thyroidectomy , MethodsABSTRACT
Objective To evaluate the safety of the da Vinci Si surgical system in thyroid surgery and to accumulate operation experience .Methods The da Vinci Si surgical system consists of a surgeon's console, a patient-side robotic cart, and high-definition 3D vision system.The robot arm tips were introduced via a single axillary incision or small chest wall ports and attached to the arms of the robot .The surgeon , sitting at the con-sole, manipulated the EndoWrist instruments and endoscope view that transfer the surgeon 's movements to the arm tips.The so called EndoWrist'technology offers seven degrees of movements ( up, down, left, right, twist, et al) , thus exceeding the capacity of a surgeon's hand in open surgery .The da Vinci Si surgical system was used to perform thyroidectomy in two small pigs .The animals were intubated and kept anesthetized with halothane .Re-sults Four surgical procedures were done using the da Vinci Si system from beginning to the end , including 2 thyroidectomies and 2 thymectomies .No conversions to open or laparoscopic procedure was used .The procedure length was 61 minutes and 50 minutes, respectively.Conclusions Robotic thyroidectomy can be performed safe-ly by the experienced surgeons after short-term da Vinci Si surgical system training .The learning curve for robotic thyroidectomy is shorter .
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Objective To explore the best operation method in the patients with papillary thyroid microcarcinoma.Methods A total of 139 patients with papillary thjroid microcarcinoma were treated at our institute between Jan.2000 and Jan.2010.The data on the clinicopathological characteristics of patients and treatment were collected.Results The mean tumor size was (0.45 ± 0.24) cm.Of the 139 patients,30.2％ had multifocal tumors,19.4％ had bilateral tumors,42.4％ neck lymph node metastases.The number of eases of lymph node metastasis in level Ⅵ,Ⅱa,Ⅲ and Ⅳ was 58(41.7％),3(2.2％),10(7.9％),5(3.6％),respectively.Only one had lymph node metastasis in Level Ⅲ Microscopic extrathyroid extension was associated with neck lymph node metastases in papillary thyroid microcareinoma patients (x2 =38.39,P ＜0.001).No one developed permanent hypoparathyroidism.The median follow-up time was 103 (range,30-154) months,and local recurrence in the thyoid was diagnosed in 2 patients who underwent hemi-or subtotal thyroidectomy.Follow-up of 10 years was done in 16 cases,and the survival rate of 139 patients for 10-year was 100％.Conclusions It suggested that patients with papillary thyroid microcarcinoma has uniform clinicopathologic characteristics and the pattern of lymph node metastasis from those with papillary thyroid carcinoma.Total thyroidectomy plus level Ⅵ dissection is the optimal surgical treatment of papillary thyroid microcarcinoma.
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ObjectiveTo investigate the changes of serum concentration of parathyroid hormone (PTH) and calcium after thyroid surgery and compare the changes among different modes of operation. MethodsFrom Aug. 2006 to Dec. 2009, 470 patients accepted thyroid surgery. The serum concentration of PTH and calcium in different groups was measured and compared before and 1 day after surgery. According to the extent and similarity of the surgery, patients were classified into 7 groups and they were compared in terms of postoperative changes of PTH and serum calcium. Statistical analysis was performed. ResultsThe serum concentration of PTH and calciurn decreased significantly after surgery in all patients except for those receiving unilateral and bilateral partial thyroidectomy. Compared with unilateral lobectomy, surgeries such as bilateral subtotal thyroidectomy, unilateral thyroidectomy with contralateral subtotal thyroidectomy, bilateral near-total thyroidectomy and total thyroidectomy resulted in more dramatic decreases of serum concentration of PTH and calcium and higher incidence of hypocalcemia ( P ＜ 0.05 ). The comparison between patients receiving CLND or not had the same result. Conclusions Almost all kinds of thyroid surgery affect the parathyroid function. The wider the surgery, the higher the possibility of postoperative hypoparathyroidism. The indications and criteria of different types of thyroid surgery are essential for hypoparathyroidism prevention. In some cases, vitamin D and calcium are recommended for preventive purpose.
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Objective To determine the clinical implications of internal mammary node biopsy for neoplasm stage,treatment,and prognosis in patients with breast cancer.Methods Internal mammary node biopsy via intercostal space was performed in 229 cases of breast cancer.Anatomical location of internal mammary nodes was recorded.Results Internal mammary node biopsy was successfully finished in 220 patients.There were 56 cases (24.45％ ) with internal mammary nodes metastasis,126 cases (55.02％ ) with axillary nodes metastasis,43 cases (34.13％ ) with regional metastases in both the axillary and internal mammary lymph nodes and 13 cases ( 12.62％ ) with internal mammary node metastasis only.Internal mammary node metastasis rate in patients with the number of positive axillary nodes ≥4 was 49.32％ (36/73).pN stage migration was seen in 56 patients with positive internal mammary nodes.There was no statistic relation between internal mammary nodes metastases and tumor location ( x2 =0.661,P =0.719).70.7％ patients with medial/central tumors and 50.7％ patients with the number of positive axillary nodes ≥4 were free from internal mammary node radiotherapy on account of internal mammary node biopsy.There was no complication such as pneumothorax or haemorrhagia.Conclusions Internal mammary node biopsy from intercostal space is a reliable surgical technique and can improve pN stage in some breast cancer patients.With internal mammary node biopsy,patients with a negative internal mammary node can be prevented from radiation to internal mammary nodal areas.
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Objective To compare HER-2 state in breast cancer tissue deteced by fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC) and analyze their correlation. Methods HER-2/neu protein expression and gene amplification were detected by FISH and IHC in 56 newly-diagnosed cases of female breast cancer from July 2008 to July 2009. Results Of the 56 patients, HER-2 protein expression (-), (+), (++), (+++) was 9 cases (16.1%), 29 cases (51.8%), 11 cases (19.6%) and 7cases (12.5%) respectively; 26 cases (46.4%) had HER-2 gene amplification while 30 cases (53.6%) didnt have. Type of HER-2 gene amplification was mainly HER-2(++) and HER-2(+++), and according gene amplification rate was 72 7% and 100%. HER-2 (+) gene amplification rate was 37.9 %(11cases) and no gene amplification was found in HER-2(-) tissue. The HER-2 positive rate using two methods had significant difference(χ2=19.778,P<0.01). HER-2(-) and HER-2(+++) had good consistency with the FISH results(Kappa=0.969),but HER-2(+) and HER-2(+ +) were poorly consistent with the FISH results(Kappa=0.271). Conclusions IHC is the preliminary screening method for detection of HER-2 expression. HER-2(-) and HER-2(+++) have good consistency with the gene amplification, and can guide clinical treatment. Some patients with HER-2(+) and HER-2(++) have HER-2 gene amplification. FISH is needed for targeted therapy.
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Objective To explore the pattern of cervical nodal metastasis and the clinical significance of total thyroidectomy plus functional neck lymphadenectomy in papillary thyroid carcinoma patients. Methods Clinical and pathological data of 172 patients with papillary thyroid cancer who underwent total thyroidectomy plus functional neck lymph node dissection at Jinan Military General Hospital were retrospectively reviewed, including patient demographics, extent of surgery, parathyroid hormone level,recurrence, tumor pathology, such as tumor size, multifocality, capsular invasion, vascular invasion,extrathyroidal extension, and lymph node status. Results Of the 172 functional neck dissection patients (47 ambilateral), the incidence of lymphonodus metastasis in regions Ⅵ, Ⅳ and Ⅲ was 96. 3% ,78. 5%and 62.1% respectively. Rate of nodal metastasis was higher in patients with extracapsular invasion than in patients with no invasion ( P ＜ 0. 05 ). Serum parathyroid hormone levels significantly decreased immediately postoperatively in total thyroidectomy plus functional neck dissection and remained low for several weeks thereafter ( P ＜ 0. 01 ). The 5-, 10- and 15-year survival rate was ( 98. 83 ± 0. 82) %, (98. 23 ± 1.02 ) % and (96. 42 ± 1.43 )%, respectively. Conclusions Therapeutic neck lymph node dissection for papillary thyroid cancer is recommended for cervical nodal metastasis patients. Total thyroidectomy plus functional neck dissection is important in the treatment of papillary thyroid cancer.