[Role of carbon nanoparticles in patients with thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection].

OBJECTIVE: To evaluate the role of carbon nanoparticles for dissecting lymph nodes and preserving parathyroid glands in patients with thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection. METHODS: A total of 86 patients with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were randomly divided into trial and control groups. Carbon nanoparticles were injected into thyroid gland of trial group. Total lymph node, metastasis lymph node, black stained lymph node and black stained metastasis lymph node of trial group were counted in central compartment dissection specimens. And total lymph node and metastasis lymph node of control group were counted in central compartment dissection specimens. Parathyroid glands in central neck dissection specimens were counted in two groups. For two groups, serum total calcium and parathyroid hormone were measured pre-operation and 1 day, 3 days, 5 days, 1 month, 3 months and 6 months post-operation. RESULTS: In trial group, the average counts of (10.19 ± 4.27) lymph nodes and (8.44 ± 4.31) black stained lymph nodes were more than those in control group at (6.26 ± 2.98) lymph nodes (all P < 0.01). Parathyroid gland was found in trial group (n = 7) and control group (n = 11). And the difference had no statistical significance (χ(2) = 1.124, P = 0.289). The preoperative serum levels of calcium and parathyroid hormone decreased within 6 months postoperatively in both groups (all P < 0.01). Without extracapsular invasion, serum levels of calcium and parathyroid hormone were higher in trial group than those in control group at 5 days, 1 month and 3 months post-operation (all P < 0.05). In an event of lymph node metastasis, serum levels of calcium (t = 3.446, P = 0.001) and parathyroid hormone (t = 2.441, P = 0.017) in trial group were higher than those in control group at 1 month post-operation. When there was extracapsular invasion or no lymph node metastasis, the serum levels of calcium and parathyroid hormone had no inter-group statistical differences within 6 months post-operation (all P > 0.05). When tumor size was less than or equal to 4 cm, the level of parathyroid hormone was higher in trial group than that in control group at 1 month post-operation (t = 2.703, P = 0.009). But no inter-group statistical differences existed within 6 months post-operation (all P > 0.05) when tumor size surpassed 4 cm. Regardless of tumor size, the serum levels of calcium in trial group were higher than those in control group at 1 month post-operation (all P < 0.01). CONCLUSIONS: For thyroid carcinoma patients, total thyroidectomy plus bilateral central neck dissection increases the incidence of hypoparathyroidism. Lymph nodes of central compartment may be tagged by carbon nanoparticles so as to boost the detection rate of lymph node. In events of lymph node metastasis or no extracapsular invasion, carbon nanoparticles can adequately protect parathyroid functions.

[The role of medical imaging plus carbon nanoparticles to manage the cervical lymph nodes in patients with thyroid carcinoma].

OBJECTIVE: The purpose of this study was to discuss the role of the combination of carbon nanoparticles and medical imaging to manage the cervical lymph nodes in patients with thyroid carcinoma. METHOD: Eighty one patients with thyroid carcinoma that primary treated were divided into two groups: trial group and control group. Carbon nanoparticles were injected into the thyroid gland of trial group patients. Central compartment (level VI) dissection, levels IIl and IV dissection, lateral node (levels II-V) dissection were performed respectively in all the patients on the basis of medical imaging and pathology. Total lymph nodes, metastasis lymph nodes, black stained lymph nodes and black stained metastasis lymph nodes of trial group were counted respectively in different dissection specimens. Total lymph nodes and metastasis lymph nodes of control group were counted respectively in different dissection specimens. Parathyroid glands of thyroid or central compartment dissection specimens were counted in two groups. RESULT: In trial group, rate of staining lymph node was 80.0% in central neck dissection tissue, 54.9% in levels III and IV dissection specimen, 39.1% in lateral node dissection specimen. In central compartment dissection tissue, lymph nodes on average in control group were less than in trial group (3.03 ± 2.07 vs. 4.72 ± 2.97) (P < 0.01). The same was in levels III and lV dissection specimen (5.53 ± 3.78 vs. 10.29 ± 3.36) (P < 0.01). As for lateral node dissection specimen,there was no statistic difference in the two group (13.4 ± 9.67 vs. 14.56 ± 6.28) (P > 0.05). There was no statistic difference between control group and trial group for the metastasis lymph nodes in difference dissection specimens. Parathyroid gland was found in 3 thyroid or central compartment dissection specimens among trial group, which was found in 9 specimens among control group, the difference had statistical significance (P < 0.05). CONCLUSION: During levels III and IV dissection in cN0 patients or central compartment dissection, lymph nodes can be signed well by carbon nanoparticles, which can improve the lymph node detection rate, but can not increase the lymph node detection rate in cN+ patients. Parathyroid gland can be preserved by carbon nanoparticles during the thyroid gland resection and central neck dissection.

[The combination of ultrasound and CT evaluate lymph node metastasis of thyroid papillary carcinoma in different compartments].

OBJECTIVE: To evaluate the role of the combination of ultrasound and enhanced CT in analyzing lymph node metastasis in thyroid papillary carcinoma (PTC) patients by compartment. METHOD: Clinical data of 115 cases (141 sides) with PTC were collected. All had undergone ultrasound in neck and enhanced CT both in neck and in mediastinum before surgery. They were divided into ultrasound group. CT group, and the combination of ultrasound and enhanced CT group to evaluate lymph node metastasis. RESULT: For the central compartment, the accuracy of ultrasound was 61.0%. CT was 48.9%, and the combination of ultrasound and CT was 62.4%. For the lateral compartment, ultrasound was 87.9%, CT was 78.7%, the combination of ultrasound and CT was 85.8%. Ultrasound had higher accuracy than CT in the central (P < 0.05) and lateral (P < 0.05) compartment. The combination of ultrasound and CT had higher accuracy than CT in the central compartment (P < 0.05), but there was no significant difference in the lateral compartment (P > 0.05). There was no significant difference in accuracy between ultrasound and the combination of ultrasound and CT neither in central (P > 0.05) nor in lateral (P > 0.05) compartment. Six cases of lymph node metastasis in mediastinum and 1 case in parapharyngeal space detected by CT were pathologically proven. CT found that five patients with pulmonary metastasis. CONCLUSION: The combination of ultrasound and CT or single ultrasound has higher accuracy in preoperative evaluation than single CT for lymph node metastasis in PTC. CT can assess some compartments such as mediastinum which can't be detected by ultrasound, and at the same time to evaluate lung metastasis. To evaluate lymph node metastasis in PTC, the combination of ultrasound and CT is more accurate and considerate than single method.

[Progress in the treatment for thyroid microcarcinoma].

Thyroid microcarcinoma(TMC) refers to the diameter less than 1cm in thyroid cancer. In recent years, with high frequency ultrasound and pathology diagnosis technology development and improvement, the incidence of TMC increased dramatically. However, there are a lot of controversy about its complication, treatment methods and value of treatment both in domestic and abroad. In this paper,we review literatures in the passed 5 years both in domestic and abroad, and investigated the progress of treatment for TMC. Agreement on the view: routine central lymph node dissection should be done regularly in the treatment thyroid microcarcinoma.

[Surgical treatment of thyroid carcinoma with the upper mediastinal invasion].

OBJECTIVE: To study the surgical management of the thyroid carcinoma with the upper mediastinal invasion. METHODS: Among the 560 thyroid carcinoma cases receiving surgery from 1988 to 1999, there were 10 cases of the upper mediastinal, the 10 cases were retrospectively analyzed for their preoperative diagnosis, surgical methods and postoperative complications. RESULTS: The upper mediastinal invasion rate of the 560 cases was 1.9% (10/516). There are three paths for the upper mediastinal invasion: (1) Trachea esophagus groove and upper mediastinal lymphatic node metastasis. (2) Tumor direct invasion. (3) Primary malignant substernal goiter. Operative methods include: (1) Tumor removal without using sternum incision. (2) Tumor removal with sternotomy. (3) Extension operation with sternum or/and clavicle bones removal. The number of those cases who survived 1, 3, 5, 10 years were 10, 8, 6, 4 respectively. Radical removal of tumors was achieved in 9 cases. The complications occurred were: 2 cases of chylous fistula; 2 cases of vocal paralysis; 1 case of thyrocervical trunk artery bleeding; 1 case of phrenic nerve paralysis; 1 case of pneumothorax. CONCLUSIONS: Surgery can be adopted for treating thyroid carcinoma with the upper mediastinal invasion, and it can have a good long-term prognosis.

[Phonation reconstruction and function assessment after total and near-total laryngectomy].

BACKGROUND & OBJECTIVE: Total laryngectomy is a common surgery pattern for treating laryngeal and hypopharyngeal cancer, but patients will lost phonation function after operation. This study was to retrospectively analyze usage of modified Amatsu, and modified Pearson operation in treating laryngeal and hypopharyngeal cancers, and to analyze phonation function by subjective and objective assessment. METHODS: Clinical data of 69 patients with laryngeal or hypopharyngeal cancer treated by total or near-total laryngectomy (modified Amatsu or modified Pearson operation) in our department from 1996 to 2003 were retrospectively analyzed. Phonation function of 69 patients was evaluated by acoustic analysis and Jiyan classification method, and compared with phonation quality of patients received vertical hemilaryngectomy (VHL) and healthy people. RESULTS: No patient appeared obvious aspiration. Four cases with post-operative radiotherapy all regained phonation function. The 3-year survival rate was 88% (22/25); 5-year survival rate was 80% (4/5). Results of acoustic assessment, and Jiyan classification method indicated that phonation function of patients received modified Amatsu or modified Pearson operation could meet daily requirements. CONCLUSIONS: Modified Amatsu and modified Pearson operations can be learnt and applied easily for phonation reconstruction after laryngectomy. They may be optional surgery patterns, especially modified Pearson operation.

[Surgical treatment of advanced thyroid carcinoma with aero-digestive invasion].

OBJECTIVE: To study the surgical management of the advanced thyroid carcinoma with aero-digestive invasion. METHODS: To analyze 18 cases of advanced thyroid carcinoma which had aerodigestive invasion retrospectively, the patients were treated from 1988 to 1998. RESULTS: The rate of aerodigestive invasion occur was 3.5% (18/516), The inner cavity invaded rate was 2.7% (14/516). The most invaded organ was trachea; The others were esophagus and larynx, pharynx; Two and/or more organs invaded rates were 44. 4% (8/18). The cases that survived 1, 3, 5 and 10 year were 17, 14, 9 and 6. The 5 years survival rates of the differentiated thyroid cancer (61.5%) were more higher than the undifferentiated thyroid cancer (20.0%), but there were no statistical difference between them (P > 0.05) and the same in clinical stage (P > 0.05). CONCLUSIONS: Intraluminal extension is a more serious problem in which usually extensive resection of the aerodigestive tract is required. Effective surgical treatment combined with postoperative auxiliary management for this kind of patients may achieve a good long term results.

[Combined treatment for advanced laryngeal carcinoma].

OBJECTIVE: To assess the efficacy of the combined therapy for advanced laryngeal carcinoma. METHODS: 204 cases of advanced laryngeal carcinoma were treated in this department from 1984 to 1997. Patients were treated by surgery alone or combined therapy including of surgery, radiotherapy and chemotherapy. RESULTS: The overall 3 and 5 year survival were 70.1% (143/204) and 61.8% (126/204) respectively. 5-year survival rate of the combined therapy group was 68.2% (90/132), whereas, 5-year survival was only 50.0% (36/72) for surgery alone group (P < 0.05). There was no statistical differences between surgery alone group and the combined therapy group in the local recurrences (P > 0.05) but distant metastases (P < 0.05). There were also no statistical differences between the preoperative radiotherapy group and the non-preoperative radiotherapy group in the terms of infection and fistula (P > 0.05). CONCLUSION: The results suggest that the combined therapy was more effective than surgery alone for the treatment of the advanced laryngeal carcinoma. Preoperative radiotherapy did not increase the incidences of infection and fistula.

[Diagnosis and surgical management of Hashimoto's disease coexistent with thyroid carcinoma].

OBJECTIVE: To study clinical assessment and management of the Hashimoto's disease coexistent with thyroid carcinoma. METHODS: A retrospective analysis in 182 cases of Hashimoto's disease treated from 1982 to 1998 were undertaken. The preoperation assessment, surgical management and the complication after operation had been studied. RESULTS: Eighteen cases of thyroid carcinoma were found in total of 182 patients. The coexistent rate of the Hashimoto's disease with thyroid carcinoma was 9.9% (18/182). Preoperative diagnostic accuracy was only 33.3% (6/18). The 5-year and 10-year survival rates were 88.9% (16/18) and 81.3% (13/16), respectively. Seven received second operation, 2 of them found cancer in the specimens . The 5 years survival rates of the differentiated thyroid cancer (88.2%) was higher than the undifferentiated thyroid cancer (0), but there were no statistical difference due to the small cases (P = 0.167). Two patients had local recurrence and 3 had metastases. They had salvage surgery, which was curative. Three patients with undifferentiated thyroid cancer died of remote metastases. Six patients suffered hypothyroidism. CONCLUSIONS: The preoperation diagnosis accuracy of Hashimoto's disease coexistent with thyroid carcinoma was low. A detail case history,computed tomography (CT), fine needle aspiration (FNA) can help the disease to be diagnosed. The surgical treatment is effective on patients with Hashimoto's disease coexistent with thyroid carcinoma.

[Application of frontal-lateral laryngectomy in laryngeal cancer treatment].

OBJECTIVE: Thirty-eight patients of laryngeal cancer were treated by extended frontal-lateral laryngectomy and the results were evaluated. METHODS: Thirty-eight patients with laryngeal cancer were treated by frontal-lateral laryngectomy and the laryngeal defects were reconstructed by epiglottic flap, bi-pedicle and bi-muscle flap and epiglottic flap plus bi-pedicle and bi-muscle flap from February 1988 to February 2000. There were 29 males and 9 females, ranging in age from 32 to 72 years old. Radical neck dissection was performed in 12 patients. 36 cases belonged to glottic cancer and 2 was superglottic cancer (T2 16, T3 22). RESULTS: The aspiration was light and the majority of cases began to eat in 10-15 days after operation. The decannulation rate was 97.3% (37/38). Wound infection occurred in 3 cases, but pharyngocutaneous fistula was not found. The three and five years survival rates were 86.1% (31/36) and 83.9% (26/31) respectively. CONCLUSION: This procedure present an ideal effect and is worthy to be recommended, but only the indication is limited.