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<p><b>OBJECTIVE</b>To evaluate the protection of parathyroid glands in bilateral papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection.</p><p><b>METHODS</b>The clinical data of 78 patients undergoing total thyroidectomy and bilateral central compartment dissection between May 2013 and May 2014 were analyzed retrospectively.</p><p><b>RESULTS</b>Among 78 patients, 131 superior parathyroid glands were protected in situ, among those, 112 parathyroid glands located at the level of inferior edge of parathyroid cartilage; 19 parathyroid glands located in the superior 1/3 part of the back sides of the thyroid glands. All the superior parathyroid glands located in the superior and lateral-superior part of the 2 cm part down from the entrance of recurrent laryngeal nerve. A total of 110 inferior parathyroid glands were protected in situ, among those, 57 glands located in the superior of inferior thyroid artery; 24 glands located just on the surface of inferior thyroid artery; 29 glands located below the superior of inferior thyroid artery. Three parathyroid glands were found in the dissected tissues and were implanted immediately. Seven parathyroid glands were found with post-operative pathologic examinations. During surgery, four parathyroid glands was found in 27 patients, three in 30 patients, two in 16 patients, and one in 5 patients.</p><p><b>CONCLUSION</b>For papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection, identification of parathyroid glands and protection of blood supply to glands are the most effective methods to prevent hypoparathyroidism.</p>
Subject(s)
Humans , Carcinoma , General Surgery , Carcinoma, Papillary , Hypoparathyroidism , Organ Sparing Treatments , Parathyroid Glands , General Surgery , Recurrent Laryngeal Nerve , Retrospective Studies , Thyroid Neoplasms , General Surgery , ThyroidectomyABSTRACT
Objective To evaluate the salvage surgery for papillary thyroid cancer patients with residual neck metastatic lymph nodes after thyroidectomy.Methods Clinical data of 97 patients undergoing salvage neck dissection between September 2007 to June 2010 were analyzed retrospectively.Results Among 97 patients,residual metastatic lymph nodes were found in 80 patients in lateroposterial neck,overall residual rate was 82.47％.Residual rate was 85.71％ in 56 patients who underwent initial lateroposterial neck dissection in other hospitals:100％ in 8 patients who underwent berry-picking; 93.33％ in 30 patients who underwent partial dissection; 66.67％ in 18 patients who underwent whole neck dissection.Residual rate was 78.05％ in 41 patients who did not undergo initial lateroposterial neck dissection.The number of dissected lymph nodes was 15-45,with an average of 23 nodes removed and 8.21 metastatic lymph nodes per case.Residual metastatic lymph nodes were found in 67 patients in central neck,overall residual rate was 82.47％,residual rate was 53.85％ in 13 patients who underwent initial central neck dissection,and 71.42％ in 84 patients who did not undergo initial central neck dissection.Conclusions Correct imaging diagnosis decreases cervical residual metastatic lymph nodes in patients with papillary thyroid cancer.Successful salvage operation lies in choosing correct mode of neck dissection and carrying out sufficient dissection.
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Objective To evaluate radical resection for thyroid carcinoma in patients without lateral neck lymph node metastasis.Methods Clinical data of 132 thyroid carcinoma patients without lateral neck lymph node metastasis undergoing radical thyroidectomy were retrospectively analyzed.Results There were 35 male and 97 female patients.Age ranged from 18 to 62 years,median age was 34.2 years.All patients underwent ipsilateral lobectomy plus isthmectomy and Ⅵ level dissection.The rate of recurrent laryngeal nerve injury was 4.5% (6/132).Taking into account of tumor invaded nerve,the rate of dissection procedure caused injury was 1.6% (2/128).Conclusion Combination of ipsilateral lobectomy plus isthmectomy and Ⅵ level dissection constitutes radical thyroidectomy in papillocarcinoma of the thyroid gland without lateral neck lymph node metastasis,recurrent laryngeal nerve exposure is the key for this en bloc resection.
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Objective To evaluate different laryngeal recurrent nerve dissections in thyroidectomy for benign and malignant thyroid diseases. Methods The chnical data of 572 patients undergoing thyroideetomy with at least one side nerve exposure were retrospectively analyzed.Results Among 572 cases,a total of 652 nerves were exposed,among those 451 were by lateral exposure,144 by inferior exposure,57 by superior exposure.Two non-recurrent laryngeal nerves were found in 572 cases.There were 6 cases referred to our department for postthyroidectomy hoarseness undergoing reexploration and it Was found that the laryngeal recurrent nerve were legated in 3 cases and severed in the other 3 cases.In this series,among those suffering from postoperative hoarseness at our own hospital,there were 3 cases in which the nerve was invaded by the tumor and it was unable to dissect the nerve intact from the tumor,while the other 4 were cases referred to our hospital for incomplete thyroidectomy and undergoing a difficult extensive second operation.Conclusions The use of lateral、inferior and superior exposure of laryngeal recurrent nerve dissection can ensure the safety and integrity of the nerve.
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Objective:To study the correlation of thymidine phosphory la se(TP) expression with histological parameters and microvessel density(MVD) in t umor stroma of oral squamous cell carcinoma(OSCC).Methods:52 cas es of oral squamous cell carcinoma and 10 cases of normal oral mucosa were immun ohistochemically stained with a SP method by using monoclonal antibody of TP and FⅧ-RA.The correlation of TP expression with the clinical data and MVD in tumo r stroma was analyzed.Results: The expression of TP in oral squa mous cell carcinoma was much higher than that in normal oral mucosa (P0.05).There was a positive correlation between the TP expression an d MVD(P