ABSTRACT
Objective To explore the treatment experience and surgical strategy in papillary thyroid carcinoma (PTC) patients with parapharyngeal lymph node metastasis. Methods A retrospective review was performed on ten patients with PTC metastasis to parapharyngeal lymph node from January 2005 to August 2014. The treatment experience and surgical strategy were analyzed. Results Three patients accepted initial treatment and 7 patients had a history of surgical treatment prior to PTC. Parapharyngeal lymph node metastasis was diagnosed by imaging examination or fine needle aspiration cytology. Resection of lymph node metastasis was performed via transcervical approach and transmandibular approach. Total thyroidectomy and neck dissection were performed synchronously. All patients received 131I therapy after surgery and did not have recurrence in neck or parapharyngeal space. During follow-up, 3 patients died in 5 years because of lung metastasis, 3 patients survived with tumor , and 4 patients survived without recurrence. The 5-year overall survival rate was 7/10 and the 5-year disease-free was 4/10. Conclusions Parapharyngeal lymph node metastasis from PTC may occur in patients with previous neck dissection or widespread cervical metastases. CT and MRI is helpful for establishing the diagnosis. Surgical resection remains the mainstay of treatment for this disease. PTC patients with parapharyngeal lymph node metastasis have a poor prognosis.
ABSTRACT
Objective To investigate the application value of transcystic choledochoscopy combined with holmium laser for common bile duct stones . Methods Clinical data of 16 patients with common bile duct stones who underwent transcystic choledochoscopy and holmium laser cholelithotripsy between March 2012 and December 2013 in this hospital were retrospectively analyzed.During holmium laser cholelithotripsy (1.0 J/10 Hz, 400 μm fiber), the stones were fragmented under direct vision of choledochoscopy and were extracted by using water flushing or a stone basket . Results The stones were successfully removed in 15 patients, including 6 cases of laparoscopic operation and 9 cases of open operation .The operation time was (132 ±27) min for open surgery and (156 ±33) min for laparoscopic surgery .The stone fragment and removal time was (30.2 ±8.5) min for open surgery and (45.6 ±10.4) min for laparoscopic surgery .The hospital stay was (9.7 ±1.4) d.There was 1 case of failed cholelithotripsy due to obstructed water flow and blurry vision .Follow-up examinations in 14 cases for 2-24 months found no recurrence of stones or biliary strictures. Conclusion Transcystic choledochoscopy and holmium laser cholelithotripsy is intuitive , accurate, and effective, being a safe and reliable alternative for choledocholithiasis .