Discussion about the safety of outpatient thyroid surgery / 中华耳鼻咽喉头颈外科杂志

Thyroid tumors are one of the most common diseases, and the thyroidectomy surgery increases. The outpatient surgery is the new trend in clinic. Is it suited for the thyroidectomy? In this article, we will analyse the setting of hospital, surgeon, surgery, patients, and so on, to prove the safety for the outpatient thyroidectomy. After the analysis, the safety of outpatient thyroidectomy surgery will be ensured only if strictly controlling the condition of hospital, surgeons and patients, and following the relation indications.

Progression of diagnosis and treatment of medullary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To review and summarize recent update on preoperative diagnostic criteria, treatment and postoperative follow-up for medullary thyroid carcinoma.@*Methods@#The relevant literatures and guidelines about medullary thyroid carcinoma were analyzed and summarized.@*Results@#In the early stages of the disease radical surgery still dominated. Ultrasound results suggested that prophylactic lateral neck dissection was required for patients with high risk factors or high levels of carcinoembryonic antigen and calcitonin need prophylactic. Early hereditary medullary carcinoma could receive prophylactic thyroidectomy based on RET gene test results. Advanced progressive medullary thyroid carcinoma could be treated with palliative surgery,molecular targeted drugs and chemotherapy.@*Conclusions@#The prognosis of medullary thyroid carcinoma is poor and lymph node metastasis is easy to occur early. The extent of initial operation should be enough. Locally advanced or distant metastatic medullary thyroid carcinoma can be treated with palliative surgery,molecular targeted drugs and chemotherapy.

Chimeric perforator flap based on the descending branch of lateral circumflex femoral artery for tongue reconstruction after advanced tongue cancer resection / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection.@*Methods@#From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation.@*Results@#Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed.@*Conclusions@#The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.

The significance and latest progress of extrathyroidal extension of thyroid cancer / 中华耳鼻咽喉头颈外科杂志

Extrathyroidal extension of thyroid cancer has been an important adverse factor affecting the prognosis of patients. According to the latest NCCN (National Comprehensive Cancer Network) guidelines, extrathyroidal extension is the surgical guide fortotal thyroidectomy in newly diagnosed patients, and its incidence in differentiated thyroid cancer is 5%-34%, belonging to T3-T4 stage.In the eighth edition of thyroid cancer AJCC staging, the T3 stage was first divided into T3a (tumor>4 cm and limited to the thyroid) and T3b (gross extrathyroidal extension invading only strap muscles from a tumor of any size), and the "minimal extrathyroidal extension(tumor invasion intoperithyroidal soft tissue or strap muscle invasion)"of the seventh edition was removed from the T stage and changed to the gross extrathyroidal extension invading only strap muscles, but there is still much controversy. It can be seen that different degrees of "extrathyroidal extension" have significant differences in the survival and prognosis of thyroid cancer. This article reviews the latest research progress of extrathyroidal extension, and discusses the significance and clinical research progress of it.

Progress in identification and protection of parathyroid gland during thyroidectomy / 中华全科医师杂志

Thyroid cancer is a common head and neck malignant tumor,it has become a malignant tumor of the highest incidence in young women in China.The treatment of thyroid cancer is a surgery-based comprehensive therapy,and the protection of the parathyroid gland during surgery has always been a major problem for clinicians.The methods for protection of parathyroid glands are in situ preservation or immediate parathyroid autotransplantation according to whether or not the blood supply can be maintained.To identify the parathyroid gland is the key issue of the protection during thryoidectomy.This article reviews the recent progress of the identification and protection of parathyroid glands at home and abroad.

Research progress in pathogenesis, treatment and prognosis of HPV positive head and neck squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Head and neck squamous cell carcinoma (HNSCC) is the sixth common malignant tumors of whole body with a high incidence, which accounts for 90% of the head and neck malignant tumors. Previous studies have shown the risk factors, such as tobacco and alcohol, are related to the occurrence and development of HNSCC. However, recent studies have shown that the non-tobacco and non-alcohol related HNSCC increased year by year. At the same time, more and more studies have shown that HNSCC is related to the infection with human papilloma virus (HPV), and the occurrence and development of HPV-positive HNSCC has own characteristics in epidemiology, pathogenesis, treatment and prognosis. In this paper the research progress for HPV-positive HNSCC is reviewed.

Application of virtual reality in surgical treatment of complex head and neck carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the application of virtual reality technology in the preoperative evaluation of complex head and neck carcinoma and he value of virtual reality technology in surgical treatment of head and neck carcinoma.@*Methods@#The image data of eight patients with complex head and neck carcinoma treated from December 2016 to May 2017 was acquired. The data were put into virtual reality system to built the three-dimensional anatomical model of carcinoma and to created the surgical scene. The process of surgery was stimulated by recognizing the relationship between tumor and surrounding important structures. Finally all patients were treated with surgery. And two typical cases were reported.@*Results@#With the help of virtual reality, surgeons could adequately assess the condition of carcinoma and the security of operation and ensured the safety of operations.@*Conclusions@#Virtual reality can provide the surgeons with the sensory experience in virtual surgery scenes and achieve the man-computer cooperation and stereoscopic assessment, which will ensure the safety of surgery. Virtual reality has a huge impact on guiding the traditional surgical procedure of head and neck carcinoma.

Level Ⅱ lymph node metastasis of papillary thyroid carcinoma / 中华内分泌外科杂志

Objective To investigate the correlation between level Ⅱ cervical lymph node metastasis (CLNM) and thyroid disease background,tumor size,location,and local lymph node metastasis in patients with papillary thyroid carcinoma (PTC).Methods A thyroid cancer database was established using Access database software.62 patients with PTC undergoing neck dissection in the 1st Department of Head and Neck surgery of Sichuan Cancer Hospital from Aug.2013 to Mar.2014 were retrospectively reviewed in terms of their sex,age,thyroid disease background,number of nodules,tumor size,location,and CLNM.Results 30 out of 62 patients had level Ⅱ cervical lymph node metastasis (Ⅱa:27 cases,Ⅱb:6 cases).13 out of 23 patients without history of other thyroid disease had level Ⅱ CLNM,9 out of 17 patients with Hashimoto's thyroiditis had level Ⅱ CLNM,3 out of 18 patients concomitant with nodular goiter had level Ⅱ CLNM and 2 patients concomitant with hyperthyroidism and having received radioactive iodine 131 treatments had level Ⅱ CLNM.Among patients with level Ⅱ CLNM,2 patients had tumors ＜10 mm,17 patients had tumors between 10 mm and 40 mm,and 4 patients had tumors ＞40 mm.Most of the tumors (11/17) with level Ⅱ CLNM were located in the upper polar of the thyroid,while the rest were located in the middle (12/23) and lower (3/12) region of thyroid.Conclusions Level Ⅱ CLNM is a common feature of thyroid carcinoma.It has been well accepted that level Ⅱ cervical lymph node should be dissected when extracapsular invasion or CLNM to level Ⅲ or Ⅳ occurs.In addition to traditional risk stratification,level Ⅰ CLNM is correlated with tumor size,location,and thyroid disease background.Therefore,close attention should be paid to level Ⅱ cervical lymph node when tumors are located in the upper polar of thyroid and individualized treatment should be chosen for each patient.

Application of CT angiography in design of anterolateral thigh perforator flap for reconstruction of defect after head and neck cancer resection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the benefits of CT angiography (CTA) in preoperative mapping of anterolateral thigh perforator flap (ALTPF) for reconstruction of defect after head and neck cancer resection.</p><p><b>METHODS</b>Twenty-four patients underwent reconstruction of postoperative defect with ALTPF from March 2011 to March 2014 were retrospectively reviewed. According to the imaging methods used for examining perforating artery, these patients were divided into two groups: color Doppler flow imaging (CDFI)-group and CTA-group, 12 patients in each group. The surgical results of all patients were evaluated for consistency in number of perforating artery, operation time and flap-related complications.</p><p><b>RESULTS</b>Only one of all patients had complete flap necrosis, with an overall flap survival rate of 95.83%. All perforating branches showed with preoperative CTA were found in operation (12/12), significantly higher than CDFI-group (8/12). The mean operation time of CTA-group was significantly shorter than that of CDFI-group (Unilateral neck dissection: (6.80±0.53) vs (8.39±0.75) h, bilateral neck dissection: (8.79±0.97) vs (10.96±0.26) h, both P<0.05). Flap-related complication occurred in one case in CTA-group, but in 5 cases in CDFI-group.</p><p><b>CONCLUSIONS</b>CTA can accurately provide anatomical information of perforator vessels and guide preoperative design of ALTPF to improve operative outcomes, including the decrease in operation time and surgical injury.</p>

Transplantation of free latissimus dorsimyocutaneous flaps for repairing head and neck defect after tumor resection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the value of free latissimus dorsimyocutaneous flap in repairing severe defect of head and neck after resection of tumor.</p><p><b>METHODS</b>Free latissimus dorsimyocutaneous flap was used to repair defect after resection of tumor in 12 patients (13 sides) with head and neck tumors. Of them 2 cases underwent radical radiotherapy before operation. and 3 cases received adjuvant radiotherapy postoperatively.</p><p><b>RESULTS</b>Aside from one flap with necrosis, other 12 flaps survived after operation including 5 cases with radiotherapy.</p><p><b>CONCLUSION</b>Free latissimus dorsimyocutaneous flap can afford large tissue, has reliable blood supply, is easy to survive, and resist to radiotherapy, which is fit for repairing severe defect of head and neck.</p>

Surgical treatment of differentiated thyroid carcinoma with larynx and trachea invasion / 中华内分泌外科杂志

Objective To discuss the surgical treatment of differentiated thyroid carcinoma ( DTC) viola-ting larynx and trachea .Methods 29 patients with DTC violating larynx and trachea received primary tumor re-section.Among them, 6 patients were with larynx violation , 3 patients with larynx and trachea violation , 16 pa-tients with trachea violation , and 4 patients with anterior strap muscles and skin violation .In addition, 5 patients were type I , 4 patients type II , 9 patients type III , and 11 patients type IV .All patients accepted the total thy-roidectomy.For patients with larynx and trachea violations , 9 received the slashing tracheal surgery ( type I and II) , 15 patients received the window resection and sternocleidomastoid muscle periosteal flap reconstruction , sleeve resection and anastomosis reconstruction , and window resection and gastrostomy .3 patients received total laryngectomy , 2 patients received partial laryngectomy and 4 patients with skin invasion received the reconstruc-tion with pectoralis major muscle flap .Results For these patients , 25 patients were with papillary adenocarcino-ma, and 4 patients with follicular carcinoma .All patients were followed up for 1 to 8 years.3 cases suffered from recurrence, 2 cases with tracheal recurrence received reoperation .3 cases with lung metastasis received the I 131 therapy, among whom 2 cases achieved the local control of lung tumor and the other one survived with tumor .1 patient died of the neck lymph nodes recurrence .25 patients survived over 3 years.13 patients survived over 5 years.Conclusions For patients with DTC with larynx and trachea violation , we should try our best to eliminate the tumor tissues.For the organs invaded by tumors , if possibly, elimination is also needed .This will eliminate or release the suffocation resulted from bleeding or obstruction .In addition , the function of larynx and trachea can be reconstructed and the life quality of these patients can be improved through the flap reconstruction and trachea anastomosis.Standard endocrine therapy and nuclear medicine therapy contribute to the prognosis improvement .