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Objective To discuss the clinical characteristics for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and significance and feasibility of preventive dissection,aimed to provide reference for clinical treatment.Methods Reviewed the clinical data of 277 patients with stage cNO papillary thyroid microcarcinoma from Jul.2011 to Dec.2015 underwent surgery in the Department of General Surgery of Lianyungang East Hospital.Evaluated the necessity of prophylactic central lymph node dissection.Adopted chi square test and Logistic regression to analyze its relationship with patients' gender,age,tumor number,tumor size,enveloped infiltration,single and bilateral tumor.All 277 patients underwent primary radical resection with ipsilateral central lymph node dissection.The specimen of resection was analyzed by routine pathology.Results The positive rate of thyroid papillary microcarcinoma lymph node metastasis was 36.8 ％ (102/277).The elements of male patients (P =0.023),age ＜ 45 years (P ＜ 0.001) and tumor diameter ＞ 0.5 cm (P =0.019)had high positive rate.The multivariable analysis showed that male patients (OR =2.63,P ＜ 0.001),age ＜ 45 years (OR =2.25,P =0.016),tumor diameter ＞ 0.5 c m (OR =2.13,P =O.009) were independent risk factors for CLN metastasis.Forty-three (15.5％) cases had transient parathyroid function.No Permanent recurrent nerve paralysis and hyperparathyroidism occurred in this group.Conclusions Prophylactic central lymph node dissection is helpful for accurate staging of tumor classification and risk assessment,has important significance,on the follow-up of patients after treatment of choice.For male patients,age ＜ 45,tumor diameter ＞ 0.5 cm,enveloped infiltration,the central compartment lymph node dissection may be necessary.
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Objective To explore the the application of sternocleidomastoid lateral path for thyroid cancer surgery lateral neck lymph node cleaning.Methods 40 patients with thyroid carcinoma were detected in the lateral neck lymph node cleaning using sternocleidomastoid lateral path(experimental group)and 40 cases of patients with thyroid cancer in the lateral neck lymph node cleaning cleaning scope with traditional operation method(control group),comparing with success rates,operation time,quality of life and incidence of complications.Results Experimental group can achieve the purpose of curing in the operation,operation field showed more clearly,the lymph node zone Ⅱ,Ⅲ,Ⅳ,Ⅴ number (32,58,50,35)were higher than traditional surgery group(17,35,33,20).Experimental group can significantly shorten the operation time[(30.0±1.20)min vs(45.0±3.10)min].The difference of incidence of near and forward future overall complications was statistically significant between the two group(P<0.05).Conclusion Sternocleidomastoid lateral path in thyroid carcinoma in the lateral neck lymph node cleaning can achieve the purpose of curing,significantly improve the lymph node zone Ⅱ,Ⅲ,Ⅳ,Ⅴ,shorten the operation time,reduce the recent and long-term complications and improve patient's quality of life.
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Objective To analysis the difference of lymph node cleaning and operative complication rate between thoracoscope surgery and routine thoracotomy on patients with thoracic segment esophageal cancer.Methods A summary of 62 patients with thoracic segment esophageal cancer in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from August 2012 to August 2014,who were carried with thoracoscope surgery,were randomly chosed and designed as the thoracosc0Pe group,and 62 patients with thoracic segment esophageal cancer over the same period,carried out with routine thoracotomy,were designed as the control group.All the clinical data of the two groups were collected.The total of thoracic lymph node cleaned and the group of thoracic lymph node cleaned were compared between the two groups.The operation time,intraoperative blood loss,chest tube placement time and postoperative hospital duration were collected and compared.All the patients were followed up at least for one year.The incidence of postoperative complications such as pulmonary infection,pneumothorax,atelectasis,recurrent laryngeal nerve injury and anastomotic leakage in the follow-up period were compared.The follow-up time,mortality and recurrence rate were compared.Results The total of thoracic lymph node cleaned(13.36±3.28) and the group of thoracic lymph node cleaned(3.35±0.84) in the thoracoscope group were lower then these of the control group ((14.22± 2.78) and (3.58±0.75)),but with no statistical difference (t =1.57,1.61,P＞ 0.05).The operation time of the thoracoscope group((314.63±38.72) min) were higher then that of the control((217.46±41.54) min),and the intraoperative blood loss ((205.73 ± 114.38) ml),chest tube placement time ((6.83 ± 1.92) d) and postoperative hospital duration((18.47±5.36) d) of the thoracoscope group were remarkably lower then these of the control ((345.72 ±175.62) m1,(10.04±2.41) d,(22.65±6.84) d,t=13.47,5.26,8.20,3.79,P＜0.05).The incidence of pulmonary infection (4.8％ (3/62)) and atelectasis (1.6％ (1/62)) of the thoracoscope group,were evidently lower then these of the control (17.7％ (11/62),1.3％ (7/62),x2 =5.15,4.81,P＜0.05).There was no significant difference in mortality and recurrence ratebetween the two groups during the follow-up period (3.2％ (2/62) vs.8.1％ (5/62),11.3％ (7/62) vs.14.5％ (9/62),x2 =1.36,0.29,P＞0.05).Conclusion There are no significant difference inlymph node cleaning between thoracoscope surgery and routine thoracotomy on patients with thoracic segment esophageal cancer,but thoracoscope surgery can shorten the length of hospital duration,reduce the intraoperative blood loss,chest tube placement time and postoperative complications.So the thoracoscope surgery is a safe and feasible operation for patients with thoracic segment esophageal cancer.
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Objective To study the advantage of using axillary fascia swelling in cleaning the lymph nodes in modified radical mastectomy. Methods 866 patients with breast cancer collected from June 2005 to June 2011 were divided into the observation group (578 cases, axilla-ry fascia swelling method) and the control group (288 cases, standard operation method), and the postoperative complications of the two groups were compared. Results In the observation group, there were 8 cases (1. 4%) of upper limb lymphatic edema, 13 cases (2. 2%) of chest wall and upper limb paresthesia, and 8 cases (1. 4%) of lymphatic leakage. The complications of the observation group were significantly reduced compared with the control group (P<0. 05), and there was no increase in the local recurrence rate (P<0. 05). Conclusion Axillary fascia swell-ing applied in cleaning lymph nodes could obviously reduce the postoperative complications after modified radical mastectomy.