RESUMO
OBJECTIVE: To explore the risk factors of level V lymphatic metastasis in papillary thyroid carcinoma (PTC) patients with pN1b. METHODS: Patients were selected if they presented with a suspicious level III or IV lymph node metastasis and underwent surgery by hemi or total thyroidectomy with a lymph node dissection (levels III, IV, VI, and VII). For these patients, if frozen section showed a positive level III or IV node, then levels II and V nodes were resected. Univariate analysis was performed using the chi-square test for some factors, including age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, status of cervical lymphatic metastasis, TNM staging, tumor deposits (independent tumor nodules), and the metastasis to more than 5 central lymph nodes. Then, the factors with statistical significance indicated by the above univariate analysis underwent multivariate analysis. RESULTS: Univariate analysis indicated that the level V lymphatic metastasis was significantly associated with simultaneous metastases to levels II, III, and IV, simultaneous metastases to levels III and IV, and tumor deposits (all p < 0.05), but it was not significantly associated with age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, other cervical lymphatic metastasis, TNM staging, and the metastases to more than 5 central lymph nodes (all p > 0.05). Multivariate analysis suggested that the simultaneous metastases to levels III and IV and tumor deposits were the risk factors of level V lymphatic metastasis. CONCLUSION: The simultaneous metastases to levels III and IV and tumor deposits are independent risk factors of level V lymphatic metastasis. The patients with pN1b PTC who have simultaneous metastases to levels III and IV or/and tumor deposits may have the risk of level V lymph node metastasis.
RESUMO
OBJECTIVE: To evaluate rehabilitation effect of Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism. METHODS: Voice rehabilitation were performed for 60 cases with Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism, in which 20 cases were involved in post-operation radiation therapy. RESULTS: Fifty two (86.7%)cases developed speech with voice and swallow rehabilitation, but 1 case of them suffered water drip from his tracheoesophageal shunt when drinking. The other 8 (11.3%) cases developed swallow rehabilitation but failed in speech rehabilitation for pharyngeal fistula (4 cases, in which 1 had pre-operative radiation therapy), tracheoesophageal shunt obstruction (2 cases), dyspnea with unknown reason (1 cases), no desire to speech (1 cases). Furthermore, all the 20 cases who were involved in post-operative radiative therapy restore their speech and swallow capability finally. CONCLUSIONS: Amatsu's tracheoesophageal shunt operation with sphincter mechanism brought effective speech rehabilitation results for total laryngectomy even with post-operation radiation therapy.