Intraoperative identification of the nonrecurrent laryngeal nerve during thyroid surgery / 中华普通外科杂志

Objective To discuss how to identify the nerve and prevent the injury of the nonrecurrent laryngeal nerve during thyroid surgery. Methods The clinical data of 3078 patients undergoing thyroid resection were retrospectively analyzed. Results From January 1981 to December 2001,3078 thyroidectomy was performed at our department with the routine exploration of the recurrent laryngeal nerve.4241 recurrent laryngeal nerves were identified,among them there were 12 nonrecurrent laryngeal nerves(0.28%,12/4241),ofwhich all were right-sided.One patient was male and 11 female.Of these 12 cases,there were 2 of type Ⅰ(16.67%,2/12),6 of type Ⅱ(50%,6/12)and 4 of type Ⅲ (33.33%,4/12).One ofthe type Ⅰ patients suffered from intraoperative injury of his nonreurrent laryngeal nerve.Conclusions The careful intraoperative identification of the nonrecurrent laryngeal nerve helps prevent it from the inadvertent injury.

Total thyroidectomy for bilateral multinodular goiter / 中华普通外科杂志

Objective To evaluate the safety and rationality of total/near total bilateral thyroidectomy(TBT) for patients with bilateral multinodular goiter(BMG). Methods From January 2003 to December 2006,311 BMG cases were preoperatively divided into two groups, 130 cases in group A underwent TBT, and 181 cases in group B were treated with subtotal/partial bilateral thyroidectomy. Results There were 6 and 2 eases in group A and group B respectively diagnosed by intraoperative frozen biopsy as BMG, but identified as papillary carcinoma by final pathology. Hence the 6 cases in group A avoided reoporation, while the 2 cases in group B underwent a resection of the remnant gland. Transient hoarseness developed in 3 (2.42%, 3/124) and 3 (1.68%, 3/179) eases in group A and group B respectively (P =0.48). Transient hypocalcemia developed in 11 (8.87% ,11/124) and 9(5.03% ,9/179) cases in group A and group B respectively(P =0.16). There was no postoperative goiter recurrence in group A, but recurrence developed in 12 cases (6.70%,12/179) in group B(P=0.02). Conclusions Total bilateral thyroidectomy is safe and rational for the management of bilateral thyroid goiter.

Clinical analysis of postoperative complications of pancreatoduodenectomy in 139 cases / 中国普通外科杂志

Objective To analyse the causes of postoperative complications of pancreatoduodenectomy(PD) and study measures for prevention and treatment of the complications.Methods A retrospective study was carried out on the data of 139 cases of pancreatoduodenectomy performed during recent 3 years in our(hospital).They included 91 cases of radical resection operation and 43 cases of pancreatoduodenectomy(combined) with vascular resection.Results There were 38 cases(27.4%) occurred complications after PD,including 10 cases(7.2%) of upper gastrointestinal hemorrhage,4 cases(2.9%) of hemorrhage in the abdominal cavity,and 6(4.3%) cases of pancreatic leakage,4cases(2.9%) of bile duct leakage,3((2.2%)) cases of intra-abdominal infection,5 cases(3.6%) of pulmonary infection,and 6 cases((4.3%)) of functional delayed gastric emptying.Four cases died during the peri-operative period.The overall mortality rate were 2.9%.Conclusions The main complications after PD were hemorrhage,pancreatic leakage,bile duct leakage and intra-abdominal cavity infection.Meticulons operative technique,the selection of appropriate anastomoses technique,careful observation and timely aggressive management in the postoperative period are the key points to reduce postoperative morbidity and motality rate after PD.

Prognostic factors and management of ruptured abdominal aortic aneurysm / 中国普通外科杂志

Objective To discuss the diagnostic methods and management of ruptured abdominal aortic (aneurysm)(AAA) and to analyse the main factors that influence prognosis.Methods The clinical data of 15 cases of ruptured infrarenal AAA treated in our hospital from 1998~2004 were retrospectively analysed. The main clinical manifestations were abdominal pain and/or back pain,low blood pressure or shock, and (pulsating) abdominal mass. 8 cases were diagnosed by DSA and/or sCTA; Doppler ultrasonic examination (suggested) rupture of abdominal aortic aneurysm in 2 cases; 2 cases had known history of AAA prior to (rupture); and 3 cases were diagnosed during operation. All of the patients underwent surgical operation. (Successful) clamping of the abdominal aorta above the neck of AAA was accomplished in 13 cases. Of these, the aorta was occluded below the diaphragm in 4 cases, and below the renal arteries in 9 cases.Results Seven cases(46.6%) died in the perioperative period. 2 died of blood loss from aneurysm that ruptured into the free abdominal cavity, 1died of myocardial infarction 5 days postoperatively, 2 died of respiratory failure 3 days and 7 days postoperatively, and 2 died of renal failure 4 days and 8 days after operation. Severe (complications) did not develop in the remaining patients.Conclusions Patients who present with the trilogy of abdominal pain and/or back pain, low blood pressure or shock and pulsating abdominal mass can be (diagnosed) easily. CT and Doppler ultrasonic examination are indicated for patients with questionable diagnosis and have stable vital signs. Operation is effective treatment for ruptured AAA. The crux of the operation is to mack an aortic occlusion proximal to the site of rupture of aorta to effectively control bleeding. Patients with rupture of AAA into the free peritoneal cavity or those with acute myocardial infarction, acute renal failure or respiratory complications had poor prognosis.