Comparative study of the treatment of bilateral multinodular goiter between hemithyroidectomy combined with contralateral nodule resection or subtotal resection and bilateral subtotal resection / 中国医学装备

Objective:To discuss the appropriate thyroid operation for the treatment of bilateral multinodular goiter.Methods: 328 bilateral multinodular goiter patients undergoing surgery in the department of general surgery of Capital Medical University Beijing Tongren Hospital from June 2012 to June 2016. were retrospectively analyzed. Of these patients, 85 underwent hemithyroidectomy combined with contralateral nodule resection or subtotal resection and 243 underwent bilateral subtotal thyroidectomy. The rate of postoperative complications and recurrence between hemithyroidectomy combined with contralateral nodule resection or subtotal resection and bilateral subtotal thyroidectomy were compared.Results: The follow-up time was 1 month to 48 months after operations. In hemithyroidectomy combined with contralateral nodule resection or subtotal resection group 1 patient developed recurrent laryngeal nerve palsy, 2 patients had transient hypoparathyroidism and 1 patient had hematoma in the operative cavity. In bilateral subtotal thyroidectomy group, 2 patients developed recurrent laryngeal nerve palsy and 2 patients had subcutaneous hematoma. The rate of recurrent disease was 2.35%(2 patients) in hemithyroidectomy combined with contralateral nodule resection or subtotal resection group and 7%(17 patients) in bilateral subtotal thyroidectomy group. There was no patient in both groups needed reoperation.Conclusions:Hemithyroidectomy combined with contralateral nodule resection or subtotal resection had similar complication rate compared with bilateral subtotal thyroidectomy, but it had a significantly lower risk of recurrence than bilateral subtotal thyroidectomy, Furthermore, the rest one lobe could be resected for many times which would not cause severe complications. Hemithyroidectomy combined with contralateral nodule resection or subtotal resection is worthed to be recommended.

Perioperative management of medullary thyroid carcinoma after bilateral adrenal pheochromocytomas resection / 中华普通外科杂志

Objective To evaluate perioperative management of MEN 2A patients with medullary thyroid carcinoma after bilateral pheochromocytomas removal.Methods Seven cases of MEN 2A from three families were diagnosed as medullary thyroid carcinoma and adrenal pheochromocytoma by biochemical tests and imaging examinations.All had histories of operations due to medullary thyroid carcinoma and contralateral adrenal pheochromocytoma.Direct sequencing of entire exons was performed in all patients.Firstly they underwent laparoscopic surgery for pheochromocytoma, then after stetoids replacement they underwent total thyroidectomy and bilateral cervical lymph nodes dissection.Results One family had the combined C634Y/D707E mutations of RET mutation.The other two families had C634Y mutation and C634R mutation separately.All patients had histories of adrenal insufficiency because of bilateral laparoscopic adrenal pheochromocytomas removal.They suffered from medullary thyroid carcinoma at the same time and needed to do total thyroidectomy and bilateral cervical lymph node dissection.Under perioperative steroids treatment and closely monitoring, they successfully went through the surgery.No adrenal crisis or related complications happened.Conclusions MEN 2A patients in this study had RET mutations and D707E mutation is a newly discovered mutation.Patients of adrenal insufficiency face the risk of adrenal crisis after a major operation.Correct perioperative monitoring and management can avoid complications.

Factors influencing postoperative prognosis in superficial femoral artery occlusive disease / 中华普通外科杂志

Objective The purpose of this study is to determine whether the TransAtlantic InterSociety Consensus (TASC) criteria (Ⅱ-2007 versions), the Society of Vascular Surgery (SVS) runoff score or risk factors for peripheral arterial disease were correlated with postoperative outcome of superficial femoral artery occlusive disease. Methods From January 2006 to September 2009, patients who suffered from lower extremity atherosclerosis occlusion disease and underwent endovascular or surgical therapy in superficial femoral artery segment were reviewed retrospectively at Beijing Tongren Hospital. Femoralpopliteal artery lesions were graded according to the TASC Ⅱ criteria. Runoff scores were determined in infrapopliteal artery segment lesions. All patients were followed up. Kaplan-Meier method was applied to calculate primary patency rate, and COX regression analysis was used to determine if TASC Ⅱ classification,runoff score, or factors for peripheral arterial disease affected primary patency rate. Results 142 patients (197 limbs) were followed up after treatment at 1 month, 3 months, 6 months, and every 6 months thereafter. Median follow-up time was 13 months. By Cox regression analysis, TASC Ⅱ classification(RR =1.471,P = 0. 012 ), runoff score ( RR = 1.190, P = 0. 004 ), and type 2 diabetic mellitus ( RR = 2. 320, P =0.019) significantly affected primary patency. Conclusions Postoperative poor patency rates are associated with higher degree of the TASC Ⅱ lesions, poor initial runoff score, and type 2 diabetic mellitus in patients of superfical femoral artery occlusive disease.

Progress in treatment of lower limb atherosclerosis occlusion / 国际外科学杂志

Surgery and endovascular techniques are the most important methods in treating lower limb atherosclerosis occlusion.Different strategies should be adopted according to the features of lesion in lower limb.This article reviews the latest clinical outcomes in treating lower limb atheroselerosis occlusion with surgery and endovascular techniques.