ABSTRACT
Objective:To explore the clinical significance of recurrent laryngeal nerve inlet zone(RLNIZ) lymph node metastasis in papillary thyroid cancer(PTC).Methods:The clinical data of the clinicopathologic characteristics of 738 cases with papillary thyroid cancer at our centers from Jul 2017 to Jun 2018 was retrospectively reviewed. 108 cases with RLNIZ lymph node dissection for pathological examination were included. The relationship between metastasis of RLNIZ lymph node and clinicopathologic characteristics was analyzed.Results:RLNIZ lymph node was detected in 12.3%(91/738)cases, the mean lymph node number in RLNIZ was 1.5±0.7, and 30.8%(28/91) cases suffered RLNIZ lymph node metastasis. RLNIZ lymph node metastasis(LNM) is associated with tumor size( P=0.028), capsular invasion( P=0.019), No. of central compartment LNM( P<0.001) and lateral neck LNM( P<0.001). No. of central compartment LNM was found to be the independent risk factor of RLNIZ lymph node metastasis. The incidence of dysphagia and inferior parathyroid damage was 0.9%(1/108)respectively. Conclusions:RLNIZ lymph node metastasis is common among PTC patients , therefore, RLNIZ lymph node should be routinely removed especially in patients with tumor size over 1cm、suspected capsular invasion and lateral neck lymph node metastasis confirmed by preoperative imaging examination.
ABSTRACT
Objective:To explore the expression and clinical significance of miR-143 in papillary thyroid cancer (PTC) .Methods:Tumor samples and adjacent tissues from 52 patients with PTC were obtained from Jan. 1st, 2018 to Mar. 31st, 2018 in Thyroid Surgery Department of the Affiliated Yantai Yuhuangding Hospital of Qingdao University. Quantitative reverse-transcriptase PCR (RT-qPCR) was used to measure the expression of miR-143 in those subjects. In addition, the relationship between the expression levels of miR-143 and the clinicopathological characteristics was analyzed.Results:RT-qPCR indicated that the expression of miR-143 was down-regulated in PTC, which was significantly lower than that in adjacent tissues ( t=-21.39, 95% CI: 18.20-15.07, P<0.001) . Low expression of miR-143 was related to the number of lymph node metastasis ≥3 in central compartment ( t=10.13, P=0.012) and lateral neck lymph node metastasis ( t=-4.67, P<0.001) . Conclusion:Downregulation of miR-143 in PTC is linked to the metastasis of PTC and may be a potential target for therapeutic intervention.
ABSTRACT
Objective To explore the clinical significance of monitoring drainage fluid parathyroid hormone (dPTH) for estimating the in situ reserves and function of the parathyroid by analyzing the change of serum calcium,serum parathyroid hormone(sPTH) and dPTH after thyroid surgery.Methods According to the operative method,the total of 144 patients with thyroid disease were divided into five groups:unilateral lobectomy,unilateral lobectomy plus isthmectomy with unilateral lymph node dissection,total thyroidectomy,total thyroidectomy with unilateral lymph node dissection,and total thyroidectomy with bilateral lymph node dissection group.The blood calcium,sPTH and dPTH level of patients were tested before operation and on the 1st,2nd,3rd and 4th day after operation.The depression of serum calcium,hypocalcemia and hypoparathyroidism were observed after operation.The serum calcium,serum PTH and dPTH level were summarized and analyzed statistically in order to evaluate the in situ reserves and postoperative function of the parathyroid.Results Among the 114 cases,the decline of serum calcium level mostly happened on the 2nd day after operation(70 cases,61.4％).There were 36 patients with hypocalcemia (31.58％) and 34 patients with hypoparathyroidism (29.82％).Serum calcium level increased gradually in all of the patients.Although sPTH level swung,it had a rising trend on the whole.The level of serum calcium and sPTH was positively correlated.The level of dPTH was discrete and decreased along with time.The decline level of dPTH among different groups had statistical difference.Conclusions It is a promising method to evaluate the in situ reserves and function of the parathyroid by monitoring the level and changes of dPTH after thyroid surgery,and it is of value for preventive calcium supplementation after thyroid surgery.
ABSTRACT
Screening has been proven to be effective for the control of colorectal cancer (CRC).The target of CRC screening is shifting from CRC to colorectal neoplasia (CN),the precursors of CRC.Based on the the latest national guideline,the Consensus of Screening for CRC and CN,and the recent research of precursors both at home and abroad.This paper summarizes the progress in the research of risk factors,risk prediction model,screening strategy optimization,colonoscopy quality control,sessile serrated adenoma identification and follow up as well as the recognition of precursors.
ABSTRACT
Screening has been proven to be effective for the control of colorectal cancer (CRC).The target of CRC screening is shifting from CRC to colorectal neoplasia (CN),the precursors of CRC.Based on the the latest national guideline,the Consensus of Screening for CRC and CN,and the recent research of precursors both at home and abroad.This paper summarizes the progress in the research of risk factors,risk prediction model,screening strategy optimization,colonoscopy quality control,sessile serrated adenoma identification and follow up as well as the recognition of precursors.
ABSTRACT
Objective@#To explore the clinical significance of metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC).@*Methods@#A total of 175 patients with PTC who underwent thyroidectomy with LNSS dissection were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors for LNSS metastasis in PTC.@*Results@#The rate of detectable LNSS was 70.9% (124/175) and metastasis rate was 7.4% (13/175). Of 13 cases with LNSS metastasis, 10 with the coexistence of cervical lymph node metastasis. Univariate Logistic regression analysis showed that multiple focal cancer, tumor located in the lower pole of thyroid, belt-shaped muscle invasion, lateral cervical lymph node metastasis, cN+ , the number of cervical lymph nodes with metastasis and the number of lymph nodes with metastasis in level Ⅳwere the risk factors for LNSS metastasis (P<0.05). Multivariate Logistic regression analysis suggested that tumor located in the lower pole of thyroid and the number of cervical lymph nodes with metastasis >6 were the independent risk factors for LNSS metastasis (P<0.05). Given the number of cervical lymph nodes with metastasis as a predictor for the LNSS metastasis, the sensitivity was 92.3%, the specificity was 66.7% and the accuracy rate was 68.6%.@*Conclusions@#LNSS metastasis is commom in PTC, with a metastasis rate of 7.4%. PTC in the lower pole of thyroid and the number of cervical lymph nodes with metastasis > 6 are independent risks for LNSS metastasis.
ABSTRACT
ObjectiveTo evaluate the safety and effectiveness of fast track surgery (FTS) in l aparoscopy-assisted radical distal gastrectomy (LADG) for gastric cancer.MethodsSixty-one patientswith distal gastric cancer were randomly divided into three groups:FTS + LADG group (n =19) undergoing LADG and FTS treatments,LADG group (n =22) undergoing LADG and traditional perioperative cares,and FTS + ODG ( open distal gastrectomy) group ( n =21 ) undergoing ODG and FTS treatments.FTS treatments included avoidance of mechanical bowel cleansing,restrictive perioperative intravenous infusion,early ambulation,early enteral nutrition.The age,sex,body weight,anastomotic mode,number of lymph node dissected,and tumor stage,serum albumin (ALB),blood urea nitrogen (BUN),C-reaction protein (CRP),flatus time,postoperative hospital stay,medical cost,and postoperative complications were compared between three groups. ResultsThe level of ALB in FTS + LADG group were higher than in LADG group at the 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.01 ).Compared to LADG group,the variation of ALB from preoperation to 4th day after surgery in FTS + LADG group and FTS + ODG group was significant( P ＜ 0.01,P ＜ 0.05 ).CRP level between FTS + LADG group and FTS + ODG group were different significantly at 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.05).FTS + LADG group has earlier recovery of gastrointestinal peristalsis than other two groups ( P ＜ 0.05,P ＜ 0.05 ).The medical cost in FTS + LADG group was less than in LADG group ( P =0.003 ),but higher than in FTS + ODG group (P ＜0.01 ).ConclusionsThe practice of FTS in LADG was safe,effective,improves nutritional status,eases stress reaction,accelerates gastrointestinal peristalsis and postoperative rehabilitation.
ABSTRACT
Objective To explore the efficiency of transcervical video-assisted mini-incision thyroidectomy for thyroid tumor. Methods 53 patients with thyroid tumors who underwent the video-assisted mini-incision thyroidectomy from Jan. 2006 to Dec. 2009 in the Department of Thyroid Surgery, Yantai Yuhuangding Hospital,were retrospectively studied. Results All of the patients, except 5 cases converting to open thyroidectomy, underwent the video-assisted mini-incision thyroidectomy successfully. The temporary recurrent laryngeal nerve injury occurred in 1 patients. The subcutaneous fluid accumulation occurred in 3 patients. The skin burns around the incisions occurred in 3 patients. There was no complication of hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period was from 3 months to 35 months. There was no evidence of recurrence and metastasis by postoperative ultrasonic and CT scan and radioiodine scintigraphy. Conclusions The video-assisted mini-incision thyroidectomy is feasible, safe, and with the advantage of cosmetic results. For thyroid tumor,especially thyroid cancer, longer follow-up is necessary to draw definitive conclusion on recurrence and survival rate.
ABSTRACT
Objective To evaluate if continuous hemihepatic inflow occlusion(HH)during hepatectomy can be as safe and effective as intermittent total hepatic inflow occlusion(TH)in reducing blood loss during hepatectomy.Methods From November 2001 to March 2006.eighty patients undergoing liver resections were included in a prospective randomized study comparning the intra-and postoperative course underTH(n=40)or HH(n=40).TH was performed with periods of 20 minutes of occlusion and 5 minutes of releasing,while HH with continuous occlusion.The surface area of liver transection was measured and blood loss was calculated.The amount of blood loss,levels of alanine aminotransferuse (ALT)and aspartate aminotransferase(AST),and postoperative course were recorded. Results The total ischemic time of the HH groups was longer than in the TH group[(42±13)min,(31±13)min,P=0.37],and the operative time in the HH group was longer than in the TH group[(236 ±49)min,(204±38)min,P=0.02 ].No signincant difierenee was found between HH and TH group in blood loss during liver parenchyma transection[(500 ±269)ml,(416 ±235)ml,P=0.14]and in the changes of ALT and AST on the first postoperative day[ALT:(677±572)IU/L,(577 ±327)IU/L,P=0.12;AST:(591 ±468)IU/L,(512±301)IU/L,P=0.66].There were no difierences on postoperative morbidity between the two groups(22.5%versus 20.0%,P=0.35).Conclusion The technique of continuous hemihepatic inflow occlusion is as safe and effective as intermittent total hepatic inflow occlusion.
ABSTRACT
Objective To explore the feasibility and efficiency of minimally invasive video-assisted thy-roidectomy on thyroid microcarcinoma, and sum up the experiences. Methods 9 patients with thyroid microcarci-noma who underwent the minimally invasive video-assisted thyroidectomy from Jan 2006 to Feb 2009, were retro-spectively studied. Results All of the patients, except 1 case converting to open thyroidectomy, underwent the minimally invasive video-assisted thyroidectomy successfully. The subcutaneous hydrops occurred in 1 patient. The skin burns around the incisions occurred in 1 patient. There were no complications of recurrent laryngeal nerve injuries, neck hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period of 15 cases were from 3 months to 37 months. There were no evidences of recurrence and metastasis by both postopera-five ultrasonic/CT examination and radioiodine scintigraphy. Conclusions The minimally invasive video-assisted thyroidectomy is safe and feasible (similar to the traditional thyroidectomy), of gratifying cosmetic results, for low-risk differentiated thyroid microcarcinoma without lymph node metastasis. For the median-risk or high-risk, more patients, comparative studies and long follow-ups are necessary to draw definitive conclusions in terms of its recurrence and survival rate.
