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Objective:To understand the correlation of different ultrasound characteristics with thyroid cancer, and evaluate the effect and safety of different surgical strategies in pathological suspected cancer and highly suspected cancer by pure ultrasound.Methods:The clinical data of 679 patients (787 thyroid nodules) underwent thyroid surgery from August 2016 to December 2019 in Beijing Daxing District People′s Hospital were retrospectively analyzed, including ultrasound characteristics (echo, margin, form, ratio of tall to wide, calcification), surgery data (operation time, surgical strategies, whether the second surgery), recovery process (whether combined with secondary injury, including hoarse voice and choking on drinking water; drainage tube retention time and postoperative drainage), pathological examination results (pathological types, whether included parathyroid gland in the submitted specimen and whether lymph node metastasis). The effect and safety were compared between dissection and non-dissection of central group lymph nodes in pathological suspected cancer patients and highly suspected cancer by pure ultrasound patients.Results:Among the 787 thyroid nodules, 316 nodules (40.2%) were malignant nodules, including 308 papillary carcinomas; 471 nodules (59.8%) were benign nodules. The rates of low echo, unclear margin, form irregularity, ratio of tall to wide >1 and microcalcification in malignant nodules were significantly higher than those in benign nodules: 90.5% (286/316) vs. 38.9% (183/471), 52.5% (166/316) vs. 11.5% (54/471), 53.8% (170/316) vs. 11.5% (54/471), 30.4% (96/316) vs. 5.5%(26/471) and 65.5% (207/316) vs. 8.7% (41/471), and there were statistical differences ( P<0.01). Among 26 patients with pathological suspected cancer, there were no statistical difference in operation time, drainage tube retention time, postoperative drainage, surgical complications and paraffin pathology result between patients with dissection of central group lymph nodes (17 cases) and patients without dissection of central group lymph nodes (9 cases) ( P>0.05); the patients with dissection of the central group lymph nodes were all proved to be cancer by paraffin pathology examination. The highly suspected cancer by pure ultrasound was in 57 cases, there were no statistical difference in operation time, drainage tube retention time, postoperative drainage, choking on drinking water or hoarse voice between patients with dissection of central group lymph nodes (23 cases) and patients without that dissection (34 cases) ( P>0.05); the incidence of parathyroid gland in the submitted specimen and malignant rate of paraffin pathology result in patients with dissection of central group lymph nodes were significantly higher than those without that dissection: 39.1% (9/23) vs. 2.9% (1/34) and 30.4% (7/23) vs. 8.8% (3/34), and there were statistical differences ( P<0.01 or <0.05). Conclusions:Thyroid ultrasound characteristics have important predictive value. It is recommended to clean central group lymph node in most cases of pathological suspected cancer; while when highly suspected cancer by pure ultrasound happens, it is recommended to clean lymph node only when lymph node metastasis is highly suspected.
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Objective To compare the effect of ultrasound-guided Mammotome minimally invasive operation and traditional surgery in treating benign breast tumor.Methods Eighty patients with benign breast tumor admitted to People's Hospital of Beijing Daxing District from October 2015 to April 2016 were randomly divided into group A and group B.Patients in group A accepted ultrasound-guided Mammotome minimally invasive operation (n =40),while patients in Group B accepted traditional surgery (n =40).Operation time,incision length,blood loss,patient satisfaction,postoperative pain,and the occurrence rates of complications were compared between the two groups.Results All the tumors in two groups were removed.Patients in group A had shorter operation time (10.4 ± 1.0) min,less blood loss (4.1 ± 0.5) ml,smaller length of incision (0.34 ± 0.04) cm (P ＜ 0.05 or P ＜ 0.01);also had less occurrence of complication (P ＜ 0.05);and patients in group A had better patient's satisfaction (95％) (P ＜ 0.01).Conclusions Ultrasound-guided Mammotome minimally invasive operation is helpful to shorten operation time and incision length,and reduce blood loss,also improve satisfaction.It is valuable for application and popularization in primary hospital.
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Objective To study the etiology,pathogenesis,diagnosis and treatment of non-traumatic splenic rupture.Method The clinical data of patients with atraumatic splenic rupture from our hospital were retrospectively analyzed,and the liferatures were reviewed.Results Most cases were male.The average age was high.The etiological factors were diverse,and the most common being blood diseases,virus infection,local inflammation and neoplasm.The pathogenesis is related to splenomegaly,increase in splenic fragility,altered haemostatic mechanisms,malposition of the spleen,and violent contraction of the diaphragm.It is more difficult to arrive at a diagnosis when compared with traumatic splenic rupture.Most patients required splenectomy,especially when the etiological factors were malignant blood diseases or splenic tumors.Some patients received non-operative treatment.The prognosis was related to the etiological factors and age.Conclusions The etiological factors of non-traumatic splenic rupture were diverse,and pathological splenic rupture was most common.A preoperative diagnosis was difficult,and splenectomy was the most common treatment.
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Objective To discuss the protective effect of carbon nanoparticles lymphatic tracer on parathyroid glands in the operation of thyroid carcinoma. Methods Retrospectively analyzed the clinical data of 65 thyroid carcinoma patients from January 2014 to October 2014, and they were divided into 2 groups according to whether injected with carbon nanoparticles. The experimental group (30 cases) were injected with carbon nanoparticles in thyroidglands before major procedure, while the control group (35 cases) were not injected. In the experimental group, there were 22 cases accepted total thyroidectomy of the affected side gland + isthmus thyroidectomy + subtotal thyroidectomy of the offside gland, and 8 cases of total thyroidectomy. In the control group, there were 25 cases accepted total thyroidectomy of the affected side gland + isthmus thyroidectomy + subtotal thyroidectomy of the offside gland,and 10 cases of total thyroidectomy. And all the 65 cases ac-cepted centrallymph nodes dissection. Results After carbon nanoparticles injection, central lymph nodes became black while parathyroid glands did not become black. The experimental group showed (2. 6 ± 0. 8) parathyroids each patient, and no parathyroid was cut by mis-take;the control group showed (1. 9 ± 0. 7) parathyroids each patient, and 3 parathyroids were cut by mistake. and the difference between the two groups was statistical meaningful (P<0. 05). There was no permanent hypoparathyroidism in the two groups. There was 1 cases of temporary hypoparathyroidism occured in the experimental group, and 3 cases occured in the control group, and there was no statistical sig-nificance difference between the two groups. Conclusion Carbon nanoparticles is benefit to the identification of parathyroid in surgery, and it can reduce the incidence of inadvertent parathyroidectomy, but it cann’ t reduce the incidence of hypoparathyroidism after procedure.
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ObjectiveTo study the therapeutic effect and feasibility of endoscopic thyroidectomy via breast areola approach. MethodEndoscopic thyroidectomy via breast areola approach was performed in 62 patients, including 16 cases of adenoma, 43 cases of nodular goiter, and 3 cases of thyroid carcinoma.ResultsEndoscopic thyroidectomy was succeeded in 62 patients, 2 cases of cutaneous emphysema, 1 case of light skin bum which diameter was 0.5 cm, 1 case of transient hoarse voice,and 1 case of puncture sinus tract bleeding. There was no converted to open surgery,no hypercapnia, no damage of recurrent laryngeal nerve or parathyriod glands. ConclusionEndoscopic thyroidectomy via breast areola approach is safe and effective,and has good cosmetic results.
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Objective To investigate the injury of the brain, lung and liver of the pups after maternal infection of human eytomegalovirus (HCMV) 3 days before pregnancy. Methods Thirty kunming mice aged 10-12 weeks were mated and divided into infection group and control group. The female mice in the infection group were given intraperitonealty 1×106 50% tissue culture infective dose of HCMV suspension 0. 5 ml 3 days before pregnancy, while those in the control group were given intraperitoncally supernatant of human fibroblasts. At 19 days of gestation, cesarean sections were performed. Pathology and HCMV DNA of the brain, lung and liver tissue of the fetus were tested through microscope and PCR. Kai-square test was used to compared the positive rates of HCMV DNA and viral isolation between these two groups. Results The positive rates of HCMV viral isolation and DNA in the fetal mice of infection group were as follow: brain (73.3% and 93.3%), liver (53.3% and 93.3%)and lung (60. 0% and 86.7%), while HCMV DNA and viral isolation was not detected in the control group (P<0.05). Under microscope, viromicrosome and tissue injury including necrosis, degeneration and bleeding were found in the tissues of brain, lung and liver in the infection group. Conclusions Maternal mice HCMV infection before pregnancy might vertically transmitted to the fetus and cause multi-organ injury.