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Objective To explore the safety and feasibility of endoscopic-assisted inguinal lymphadenectomy via a small incision (3 cm) for vulvar carcinoma . Methods From September 2013 to December 2015, local wide excision and endoscopic-assisted inguinal lymphadenectomy via a 3-cm incision was performed to treat vulvar carcinoma in 6 women.There were 2 cases of unilateral operation and 4 cases of bilateral operations .A small incision (3 cm) was made in the groin.The skin edge was lifted to separate subcutaneous tissue and obtain a surgical exposure .Then endoscopic inguinal lymphadenectomy was conducted . Results The surgeries were successful in all the 6 patients, with no conversion to open surgery or intraoperative secondary injury .The operation time of inguinal lymphadenectomy was 60-90 min (78.3 ±14.7 min), and the blood loss was 20-40 ml (31.6 ±9.8 ml).The number of lymph nodes desected was 3-13 (8.7 ±3.0) in each side.Pathological examinations showed squamous cell carcinoma . The FIGO staging showed 2 cases of stage ⅠB and 4 cases of stage Ⅱ.The postoperative stitches removal time was 7-9 d (7.8 ±0.7 d) .No surgical complications , such as incision disruption , delayed healing , inguinal skin necrosis , or lower extremity lymphedema , were recorded during a 3-12 months (6.5 ±4.4 months) of follow-up.No tumor recurrence or metastasis was found . Conclusions Endoscopic-assisted inguinal lymphadenectomy via mall incision in the treatment of vulvar carcinoma is effect , safe and feasible .It achieves radical effects .
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Objective To explore the home-made U-shaped retractor ’ s effect on reducing the traction injury of recurrent laryngeal nerve in the video-assistance thyroidectomy . Methods The patients with unilateral and unifocal papillary thyroid microcarcinoma , which were diagnosed by ultrasound preparation and by pathological postoperation , were enrolled .They all underwent the ipdilateral lobectomy , isthmus resection and the clearance of central lymph nodes with video-assistance technology .From January 2013 to June 2014, 79 cases ( control group ) were received conventional method , by which the thyroid lobe was elevated onto the trachea surface.From January 2015 to March 2016, 71 cases (U-shaped group) accepted the procedure which adopted home-made U-shaped retractor to pull the thyroid lobe to carotid artery horizontally .The operations were completed by the same surgeon .There were no significant differences between the two groups in age , gender and lesion size , which is comparable .The incidence rate of hoarseness was compared postoperation . Results Postoperative hoarseness of the U-shaped group occurred in 6 cases (8.5%) and the control group in 17 cases (21.5%), which show a significantly statistical difference (χ2 =4.919, P=0.027).And there was no significant difference in voice recovery time [median:16.5 d (8-31 d) vs.18 d (4-50 d), Z=-0.246, P=0.806]. Conclusion In the video-assisted thyroidectomy , using the U-shaped retractor to pull the thyroid lobe laterally and horizontally will be beneficial to reduce the recurrent laryngeal nerve tension and the incidence of the retract injury .
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Objective To investigate the feasibility and safety of minimally-invasive video-assisted parathyroidectomy ( MIVAP) for parathyroid adenoma ( PA) . Methods Clinical data of 14 patients with primary hyperparathyroidism ( PHPT) caused by PA between April 2011 and September 2014 in our hospital were analyzed retrospectively.Coexistent thyroid lesions were found in 6 patients.With preoperative definite diagnosis and localization, we performed parathyroidectomy and local excision or lobectomy of the thyroid gland.All the patients were confirmed by intra-operative fast frozen section pathological examination and postoperative pathological immunohistochemistry.Intra-and post-operative parathyroid hormone monitoring was conducted.Hoarseness, choking cough, and active bleeding were observed. Results All the procedures were accomplished successfully, without intra-operative abnormal blood loss or conversion to conventional operation.The operative time was 35-60 min ( mean, 50 min);the intra-operative blood loss was 1.7-32.0 g (mean, 9.75 g).Neither transient nor everlasting injury to recurrent laryngeal nerve or superior laryngeal nerve happened.No hemorrhage was observed.All the patients were followed up for 2-43 months ( mean, 16 months) , during which there was no recurrence. Conclusion MIVAP with thyroidectomy is feasible and safe for PA and coexistent benign thyroid lesions, on the basis of pre-operative adequate diagnosis and proper localization and intra-operative parathyroid hormone monitoring.
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Objective To investigate the feasibility and safety of three-dimensional video-assisted thyroidectomy (3D VAT). Methods During January to April of 2014, 10 cases with unilateral or bilateral thyroid benign diseases , thyroid cancer, or parathyroid lesions were enrolled .The 3D VAT was carried out by using a 10-mm 3D stereoscopic endoscope .Local excision or lobectomy was performed via a 2-4 cm curve skin incision one finger above the sternal notch .In two patients , lobotomy combined with systematic lymphadenectomy was performed when papillary thyroid microcarcinoma was identified during operation . Results All the procedures were accomplished successfully under 3D video-assisted system, without intra-operative abnormal blood loss or conversion to conventional thyroidectomy .The operative time was 30-90 min (61.8 ±22.4 min);the intra-operative blood loss was 1.3-93.0 g (median, 5.2 g).All the patients were followed up for 1-4 months.Neither intra-nor post-operative complications about recurrent laryngeal nerve , superior laryngeal nerve , or parathyroid were observed . Conclusions Preliminary impression emerging from this study seems to suggest that 3D VAT is safe and effective.Compared with 2D surgery, a good perception of depth and easy recognition of anatomic structures are noticeable .
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Objective To study the distribution and clinicopathological characteristics between VEGF-C and pefitumoral lymph vessels density(PLVD) in breast cancer tissue, and to investigate the development and the mechanism of breast cancer-related lymphoedema (BCRL). Methods VEGF-C and VEGFR-3 were detected by using immunohistochemical technique for the detection of VEGF-C and its receptor VEGFR-3 in forty-seven breast cancer specimens. We measured the patients' circumferences of bilateral upper limbs to determine whether there was lymphoedema and made classification in the follow-ups. Results VEGF-C was positive in 33 out of 47 cases. PLVD significantly increased in VEGF-C positive groups (30.39±10. 46) than in negative groups (23.16±11.67) (P<0.05). VEGF-C semi-quantitative score was in a positive correlation with PLVD (r=0.334). The positive expression rate (42.55%) and semi-quantitative score (3.68±1.59) of VEGF-C increased in the lymph node positive group than in the negative group, PLVD increased in the lymph node positive group compared with that in negative group (32.12±10.29 vs. 24.82±11.06), P<0.05. The risk of lymphoedema increased in the VEGF-C negative group (5/14) compared with that in the positive group (3/33) (P<0.05). Conclusion VEGF-C has a high rate of positive expression in breast cancer, and is positively correlated with PLVD. High expression of VEGF-C can reduce the risk of BCRL in breast cancer.
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Objective To investigate the expression of nm23-H1 in human benign and malignant colorectal lesions and the relationship between invasion,metastasis in colorectal carcinoma.Methods The expression of nm23-H1 were determined by ABC immunohistochemical technique in 80 cases human colorectal carcinoma,and compared with that in adenoma and normal mucus.Result Positivity expression rates of nm23-H1 were 66.7% in colorectal carcinoma.No significant difference of the expression of nm23-H1 in normal mucus,adenoma and cancerous tissue (P>0.05).The positive rates of nm23-H1 expression in different pathological grading,lymph node metastasis and post-operative survival (3 years) were showed significant difference (P<0.05).Conclusions It is suggested that the deletion of nm23-H1 low expression might play an important role in the carcinogenesis,development,metastasis and prognostic value of human colorectal carcinoma.