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Objective:To investigate the effect of 25 hydroxyvitamin D [25 (OH) D] on postoperative parathyroid function in patients with papillary thyroid carcinoma (PTC) .Methods:426 patients who diagnosed as PTC and underwent at least total thyroidectomy plus central lymph node dissection (including lateral lymph node dissection) in Center of Thyroid and Parathyroid Surgery of West China Hospital, Sichuan University, from Jun. 2017 to Sep. 2019 were retrospectively analyzed. Among them, 313 were women and 113 were men, they were divided into vitamin D deficient (VDD) group ( n=297) and normal group ( n=129) according to preoperative 25 (OH) D levels ≤ 20ng/ml and > 20ng/ml. SPSS 23.0 statistical software was used for data processing. Pearson χ2 test or Fisher exact test were used to compare the incidence of clinical hypoparathyroidism, biochemical temporary and biochemical permanent hypoparathyroidism between the two groups. Univariate and multivariate logistic regression analysis were used to analyze the related factors of postoperative hypoparathyroidism between the two groups. Results:Preoperative 25 (OH) D level was significantly correlated with postoperative biochemical temporary hypoparathyroidism ( P=0.04, OR=1.11) . Compared with patients with adequate preoperative vitamin D, preoperative vitamin D deficiency increased the risk of biochemical transient hypoparathyroidism by 6.67 times ( P=0.03;OR=6.67) . There was no significant correlation between preoperative vitamin D deficiency and early postoperative clinical hypoparathyroidism (2.7% vs 3.9%, P=0.55) . Conclusion:Correction of vitamin D deficiency before operation may reduce the incidence of postoperative temporary hypoparathyroidism caused by 25 (OH) D deficiency.
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Objective To investigate anti-ulcerative drug (AUD) utility in patients undergoing thyroid operation against stress ulcer (SU ) during perioperative period .Methods A total of 393 patients undergoing arthroscopic operation during Jan . to Dec .2013 in our hospital were recruited and retrospectively analyzed with Excel spreadsheet .Results Among 393 patients in the study ,eighty-five patients (21 .6% ) used AUD (92 .9% )after operation ,most (94 .9% ) were administered by intrave-nous ,and drug utilization index (DUI) was 1 .48 .Eighty-seven point one patients used proton pump inhibitors (PPIs) in which lansoprazole was prescribed most .Conclusion PPIs were overused in patients undergoing thyroid operation .
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Objective To study the clinical value of exposure of recurrent laryngeal nerve in thyroid operation for the prevention of recurrent laryngeal nerve injury. Methods A total of 90 patients received thyroid operation in our hospital from April 2012 to August 2014 were enrolled and randomly divided into observation group(n=45) and control group(n=45) according to whether the recurrent laryngeal nerve were exposed during operation. The patients in observation group received thyroid operation with recurrent laryngeal nerve exposure, and the patients in control group received conventional thyroid operation. Then recurrent laryngeal nerve injury situation and operation situa-tion were compared. Results Recurrent laryngeal nerve injury symptoms were less in the observation group (2. 22%) compared with that of the control group (15. 56%) with a statistically singnificant difference(P0. 05). Conclusion Exposure of recurrent laryngeal nerve in thyroid operation is helpful to prevent recurrent laryngeal nerve injury,which reduce the damage recovery time,although it will extend the operation time,does not increase bleeding and drainage volume.
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Objective To investigate perioperative antimicrobial prophylaxis in thyroid operation at all levels of hospitals in a province.Methods From January 1 ,2011 to December 31 ,2013,all kinds of thyroid operation in a province were conducted targeted monitor,investigated results were analyzed.Results A total of 1 304 cases of thy-roid operation were investigated,1 294 (99.23%)were elective operation;duration of operation of 1 051 cases (80.60%)were ≤2 hours;antimicrobial use rate was 96.70%;196 patients (15.45%)were administered 30 mi-nutes before operation,887 patients (70.34%)used antimicrobial agents for >48 hours;19.53% of patients used the first generation cephalosporins and clindamycin.Conclusion There are some problems in antimicrobial use in thyroid operation in this province,such as inappropriate choice of antimicrobial agents,improper administration time,long time use of antimicrobial agents,and use antimicrobial agents without indications.Management of anti-microbial agents should be strengthened,so as to promote the rational use of antimicrobial agents.
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Objective To compare and analyze the curative effect and security of thyroidectomy with minimal incision in neck under laparoscopy and traditional open thyroid operation to treat thyroid benign neoplasm. Methods A total of 68 cases of patients with thyroid benign neoplasm were given the operation in Beilun District People's Hospital during the period from January 2013 to January 2014, and they were divided into laparoscopy assisted group (n=34) and control group (n=34). The patients in laparoscopy assisted group were given minimal incision in neck under laparoscopy, while the patients in control group were given open thyroid operation. The operation time, intraoperative amount of blood, postoperative amount of drainage, time of extubation, incision length, length of stay (LOS) and operative occurrence of complication were observed and compared. Results The operation time, intraoperative amount of blood, postoperative amount of drainage, time of extubation, incision length, length of stay (LOS) and operative occurrence of complication of patients in laparoscopy assisted group [(53.75±12.76)min, (12.46±3.27)mL, (28.89±6.47)mL, (2.13±0.57)d, (3.17±0.84) cm, (3.45±0.73)d, 5.9%]were obviously shorter or less or lower than those in control group [(85.46±15.46)min, (14.68±4.18)mL, (32.18±7.03)mL, (3.42±0.64)d, (5.42±1.13)cm, (4.88±0.95)d, 23.5%] (P<0.01 or P<0.05). After a median fol low-up of (9.7±1.8) months (range from 4 to 16 months), 1 case in laparoscopy assisted group and 3 cases in control group were recurred. The recurrent rate in two groups had no difference(χ2=0.27, P>0.05). Conclusion Compared with traditional open thyroid operation, thyroidectomy with minimal incision in neck under laparoscopy to treat thyroid be-nign neoplasm have the following advantages, shorter operation time, less intraoperative amount of blood, quicker post-operative recovery, more favorable cosmetic effect, less postoperative complication and so on.
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Objective To study preoperative nursing intervention mode for thyroid surgery and its effect.Methods 78 patients were randomly divided into two groups.39 patients in the intervention group received psychological care 30 minutes before operation besides preoperative interview 24 hours before operation,while 39 patients in the control group received routine visit 24 hours before operation.Indexes including the values of blood pressure,heart rate and the SCOre of anxiety of the two group patients were measured and recorded before interview and before anesthesia.Results There were no difference in the observational indexes between the two groups before interview(P＞0.05),while after intervention(before anesthesia),the values of blood pressure and heart rate and the Score of anxiety in the intervention group were lower than those in control group (P＜0.01).Conclusion Preoperative systematic interview combined psychological care before operation is an effective nursing intervention mode,it can help patients who will receive thyroid surgery reduce the fluctuation of blood pressure and heart rate,and it can also relieve the preoperative anxiety.
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PURPOSE: Transient hypocalcemia is frequently observed after thyroid operation for most cases. The symptoms are recovered through calcium administration, but some patients suffer from permanent hypocalcemia. METHODS: We analyzed the medical records of 723 cases who underwent thyroidectomy from Mar 2001 to Dec 2002. Hypocalcemia is defined as case of decreased ionized calcium, and hypoparathyroidism as case of decreased PTH for more than 1 year or decreased ionized calcium despite of administration of calcium more than 1 year. RESULTS: Out of 723 cases of operation; 139 cases (19.2%) were presented with hypocalcemia after operation. But patients with hypocalcemic symptoms were only 67 cases (9.3%) and with hypoparathyroidism were 15 cases (2.1%). On the basis of operation range, hypocalcemia and hypoparathyroidism were observed more frequently in case of total thyroidectomy (46.9%) than in the cases of operation less than total thyroidectomy (53.1%). Out of total patients, 285 cases(39.4%) were benign while 438 cases (60.6%) were malignant histologically. Hypocalcemia were observed from 22 benign cases and 117 malignant cases, indicating significant difference between the two groups of patients (P <0.001). 2 benign cases and 13 malignant cases had hypoparathyroidism, also indicating significant difference between two groups of patients (P=0.037). In cases of extrathyroidal extension, more frequent hypocalcemia (P<0.004) and hypoparathyroidism were observed (P=0.048). On lo gistic analysis, total thyroidectomy (P=0.004) and extrathyroidal extension (P=0.048) constituted independent risk factor for immediate hypocalcemia and completion thyroidecotmy (P=0.018) and extrathyroidal extension (P=0.037) for permanent hypoparathyroidism. CONCLUSION: Postoperative hypocalcemia is affected substantially by the extent of thyroidectomy. Therefore close attention is necessary to check and preserve parathyroid glands in case that extent of surgery is more than total thyroidectomy.
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Humanos , Cálcio , Hipocalcemia , Hipoparatireoidismo , Prontuários Médicos , Glândulas Paratireoides , Fatores de Risco , Glândula Tireoide , TireoidectomiaRESUMO
OBJECTIVES: The thyroid disease is the common form of endocrine diseases, which often requires surgical management. Recently, fine needle aspiration biopsy is widely used preoperatively. As a result, some studies show that numbers of thyroid operation have decreased significantly. We performed this study to analyze the clinical features of thyroid diseases and the trend of thyroid operation in Korea. METHODS: We reviewed medical records of 1787 cases with thyroid diseases who were managed surgically in Catholic Medical Center, Korea from 1988 to 1992. RESULTS: 1) The percentage of thyroid diseases in total cases undergoing operation in Department of General Surgery was 3%, which tended to decrease with time.2) 72.9% of thyroid diseases was benign. Among them, the frequency of nodular hyperplasia and follicular adenoma were 67.5% and 18.4%, respectively.3) The percentage of thyroid cancers in thyroid diseases was 27.1%, which tended to increase with time. The frequency of papillary adenocarcinoma was 78.6%, follicular adenocarcinoma 18.2% and medullary carcinoma 1.5%.4) Thyroid cancers were most commonly found in the forty and sixty decades. Male:female ratio was 1:8.5.5) 7.6% of thyroid cancers was accompanied by benign thyroid diseases which were mostly nodular hyperplasia and follicular adenoma.6) The most common type of operation was lobectomy (82.5%) in benign thyroid diseases, and total thyroidectomy (47.1%) and lobectomy (41.1%) in thyroid cancers.7) Fine needle aspiration biopsy was performed in 51.7% of thyroid nodules, the frequency of which tended to increase with time. The sensitivity, specificity, false negative rate and false positive rate of this test were 78.3%, 89.4%, 13.7% and 17.2%, respectively. CONCLUSION: With the use of fine needle aspiration biopsy, numbers of thyroid operation decreased and the percentage of thyroid cancers in thyroid operation increased.