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Objective:To compare the effectiveness of areola approach endoscopic thyroidectomy (AET) and conventional open thyroidectomy (OT) in treating papillary thyroid carcinoma.Methods:Four hundred and twenty-eight female patients with papillary thyroid carcinoma who were treated at the Department of General Surgery, Beijing Friendship Hospital between January 2017 and January 2020 were included according to the inclusion and exclusion criteria, of whom 183 underwent AET (AET group) and 245 underwent OT (OT group). Direct comparison and subsequent propensity score matching methodology were utilized to compare the differences between the two operation methods in terms of surgical time, intraoperative parathyroid transplantation rate, intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. Data analysis was performed by using SPSS 25.0 software. The metric data of normal distribution was represented by mean ± standard deviation ( ± s), and the t-test was used for between-group comparison. The Chi-test was used for between-group comparison of count data. Results:The AET group had an age of (38.89±9.08) years, weight of (62.10±10.45) kg, and height of (161.97±5.31) cm; the OT group had an age of (45.88±12.47) years, weight of (65.11±12.72) kg, and height of (161.62±5.24) cm. The differences in age, weight, and body mass index between the two groups were statistically significant ( P<0.05). The surgical time in the AET group was (183.00±137.22) min, which was significantly longer than (87.94±28.25) min of the OT group ( t=16.67, P<0.001). The parathyroid transplantation rate in the OT group was significantly higher than that in the AET group (49.39% vs 34.97%, χ2=8.87, P=0.003). There were no statistically significant differences between the two groups in terms of intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. After propensity score matching based on differences in age, weight, body mass index, and soon, 183 cases of AET (AET-PS group) and OT (OT-PS group) were obtained for statistical analysis. The surgical time in the AET-PS group was (137.22±32.77) min, which was significantly longer than (90.26±29.35) min of the OT-PS group ( t=14.44, P<0.001). The parathyroid transplantation rate in the OT-PS group was significantly higher than that in the AET-PS group (53.01% vs. 34.97%, χ2=12.08, P=0.001). There were no statistically significant differences between the two groups in terms of intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. Conclusions:AET and OT are equally safe and effective in treating papillary thyroid carcinoma. AET surgery can be performed safely and feasibly under strict adherence to surgical principles.
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Objective:To compare the diagnostic efficiency of colloidal gold dipstick method (PTH dipstick method) with that of doctors’ experience method based on nano-carbon method for rapid identification of parathyroid gland in thyroidectomy of thyroid cancer.Methods:From March to July 2020, 90 patients underwent thyroid surgery in the Friendship Hospital, Capital Medical University participated in the experimental study, and 155 samples underwent empirical judgment, parathyroid dipstick and pathological examination. All operations were performed by senior specialists. SPSS statistics 17.0 software was used for statistical analysis.Results:Seventy-four cases of parathyroid gland confirmed by both pathology and empirical judgment, and 81 cases of non-parathyroid gland confirmed by pathology; 130 cases of parathyroid glands confirmed by both PTH dipstick method and pathology, and 22 cases of non-parathyroid glands confirmed by pathology. The accuracy rate of PTH dipstick method was 85.53% which was much higher than that of empirical judgment method (47.74%). The data were statistically significant ( χ2=49.14, P<0.05). The sensitivity of PTH method was 95.89%, the specificity of PTH method was 75.94%, and the Youden index was 0.7183. The sensitivity of empirical judgment method was 81.3%, the specificity of empirical judgment method was 47.74%, and the Youden index was 0.2904. Conclusions:The diagnostic efficiency of the PTH method is higher than that of empirical judgment method to identify parathyroid gland in thyroid surgery. The two methods can be used together to increase the protection of parathyroid gland during operation.
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Objective:To compare the effect of layer dissection and traditional management in total thyroidectomy by comparing the levels of parathyroid hormone and calcium after operation.Methods:From January 2019 to June 2019, a total of 120 patients who underwent total thyroidectomy were retrospectively analyzed, in including 96 females and 24 males, aged from 24 to 72 years old, with the average of 52 years. There were 63 cases in layer dissection group and 57 cases in traditional management group. The main index was the level of parathyroid hormone and blood calciumon the 1st day after operation. The measurement data of non normal distribution were described by quartile [ M( P25, P75)]. T-test or nonparametric test were used for comparison between groups. The chi-square was used to conduct comparison between count data of groups. Results:On the first day after operation, the serum calcium level in the layer dissection group was significantly higher than that in the traditional management group, with a median of 2.15 mmol/L and 2.10 mmol/L, respectively ( Z=-2.019, P=0.043). The level of parathyroid hormone in layer dissection group was significantly higher than that in traditional management group [23.8 (16.2~34.8) pg/mL vs 15.3 (8.9~29.0) pg/mL, Z=-3.646, P<0.001]. The incidence of postoperative complications in the layer dissection group was lower than that in the traditional management group (6.3% vs 21.1%, χ2=5.599, P=0.018). One month after operation, the results of blood calcium and parathyroid hormone were both normal [blood calcium 2.31 (2.23~2.41) mmol/L vs 2.32 (2.26~2.37) mmol/L, Z=-0.657, P=0.648 and parathyroid hormone 37.6 (32.3~51.1) pg/m vs 35.8 (27.7~48.9) pg/mL, Z=-0.674, P=0.499], and there was no significant difference between the two groups. Conclusion:The layer dissection method for the superior pole thyroid capsule, compared with traditional management, can reduce the incidence rate of postoperative hypocalcemia and the incidence rate of postoperative complications, can improve the quality of patients′ life.
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Objective:To explore whether endoscopic surgery can achieve the same effect on thyroid cancer as open surgery.Method:44 cases were selected to endoscopic thyroidectomy with breast areola approach, who were prepared to accept the surgical treatment of thyroid cancer with cT1N0 stages, female, ≤60 years old, no history of neck surgery and beauty desire. Fifty patients with the same conditions undergoing thyroid open surgery were as the control group.Results:Operative time of endoscopic group[ (170.0±28.0) min] was longer than that of the open operation group[ (90.0±21.0) min ( t=15.610, P=0.000) ]. There was no significant difference between the two groups in surgical complications ( P>0.05) . There was no statistical difference between the number of paratracheal and anterior tracheal lymph nodes of endoscopic group (6.0 ±4.2) and open surgery group (5.5 ±3.7) ( t=0.692, P>0.05) . There was no statistical difference between the number of anterior laryngeal lymph nodes of endoscopic group (0.7 ±1.1) and open surgery group (0.5 ±0.9) ( t=1.186, P>0.05) . Conclusion:The breast areola approach endoscopic thyroidectomy is safe and reliable in treatment of thyroid cancer, and the central cervical lymph node dissection is sufficient, which can be used as the choice of operation mode for thyroid cancer patients in cT1N0 stage.
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Objective To analyze the correlation between the primary lesion of papillary thyroid microcarcinoma (PTMC) and the metastasis of cervical lymph node,explore the surgical method of PTMC.Methods From Jan.2013 to Nov.2016 in Beijing Friendship Hospital,Capital Medical University,there were 545 cases of PTMC treated with surgery,induded 432 females and 113 males (3.82 to 1),aged 14 to 80 years old (average 46.7 ±11.8 years).Surgical methods:the percent of total or near total resection was 70.6％ (385/545),lobectomy and isthmectomy was 29.4％ (160/545).There were 524 cases of lymph node dissection in the central region of the neck,of which 78.3％ (427/524) were unilateral swept,and 17.8％ (97/524) were swept on both sides.There were 14 cases of lymph node dissection in the neck area.There were 930 thyroid lobe specimens,622 lymph node specimens in central neck region and 14 lymph node specimens in lateral neck region.In this study,576 specimens of thyroid gland and the same side cervical lymph nodes were selected.The diameter was (0.58 ± 0.25) cm.There were 513 single lesion cases (89.1％) and 63 multiple lesion cases (10.9％).There were 441 cases (76.6％) without extrathyroid invasion and 135 cases (23.4％) with extrathyroid invasion.The number of cervical central area lymph nodes was 4.7 ± 3.8.The transfer rate of cervical central area lymph nodes was 31.8％.The number of cervical lateral area lymph nodes was 17.8 ± 10.0.The transfer rate of cervical lateral area lymph nodes was 2.4％.SPSS 19.0 statistical software was used.for statistical processing,and the standard deviation of the measurement data was expressed as the standard deviation.The counting data was expressed as a percentage,and the chi-square test was used for the comparison between groups.The single factor correlation was analyzed by Pearson.The statistical methods included independent sample t test,Pearson correlation analysis and x2 test.Results There was high positive correlation between diameter of PTMC and transfer rate of cervical central area lymph nodes (r =0.847).The transfer rate of cervical central area lymph nodes was significantly increased when focus diameter was greater than 0.8 cm.There was significant positive correlation between diameter of PTMC and transfer rate of cervical lateral area lymph nodes(r =O.557).The transfer rate of cervical lateral area lymph nodes was significantly increased when focus diameter was greater than 0.9 cm.The transfer rate of cervical central and lateral area lymph nodes to multi focus cases were similar to single focus cases.The transfer rate of cervical central and lateral area lymph nodes to thyroid capsule invaded cases were higher than thyroid capsule non-invaded cases.Conclusions The focus diameter and capsule invasion of PTMC were related to cervical lymph node metastasis.The number of cancer lesions is not related to cervical lymph node metastasis.As early as possible,surgical operation can lead to timely treatment of many PTMC cases,of which cervical lymph node metastasis has occurred,but preoperative diagnosis can not be obtained.Surgical methods of initial treatment were total/near total thyroidectomy or thyroid lobectomy plus unilateral/bilateral cervical central area lymph node dissection and/or add to cervical lateral area lymph node dissection.
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Objective To investigate the ultrasonographic characteristics,pathological diagnosis and surgical treatment strategy of follicular thyroid carcinoma (FTC).Methods The clinical data of 10 patients with FTC confirmed by histopathology from Jul.2013 to Oct.2017 in Beijing Friendship Hospital,Capital Medical University were retrospectively analyzed including 3 males and 7 females with mean age of 41.5 (15 to 68) years old.The clinical data including preoperative ultrasonographic features,fine needle aspiration results,intraoperative frozen section examination and surgical treatments of these 10 patients were retrospectively analyzed.Descriptive methods were used for Statistical analysis.Results Ultrasonography was performed in all 10 patients,and frozen section examination was performed in 6 patients,of which,5 were considered capsular invasion.Ipsilateral centralcompartment neck dissection was performed in 2 patients,no node metastasis was found.Reoperation were performed in 5 patients with total or near total thyroidectomy.No severe complications such as persistent hypoparathyroidism and recurrent laryngeal nerve injury occurred in all 10 patients.The median follow-up time was 34.4 months,and no one died during the follow-up period.Conclusions Preoperative diagnosis of FTC is difficult.The reoperation rate is higher than that of papillary thyroid carcinoma.Lobectomy plus isthmusectomy should be the initial surgical procedure for follicular tumors,while neck dissection is not recommended.
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Objective To analyze the clinical efficacy of the laparoscopic breast-conserving surgery combined with radiofrequency ablation to treat the early-stage breast cancer.Methods We collected 55 patients diagnosed early-stage breast cancer in retrospect,which started from January 2014 to December 2016.Twenty-seven of them were performed the laparoscopic breast-conserving surgery combined with radiofrequency ablation while others went through laparoscopic breast-conserving surgery without radiofrequency ablation.Meanwhile,we adopted the student t-test and the chi-square test to compare results of two groups.More specific,the main indexes of this study are including the post-operative local recurrence,the incidence of fat liquefaction or the incision-infection,operation time,post-operative hospital stay and the hospitalization expense.Results The laparoscopic breast-conserving surgery combined with radiofrequency ablation group had low local-recurrence than the laparoscopic breastconserving surgery group (0 and 7.69％).Additionally,there were no statistical differences between two groups in the incidence of fat liquefaction.However,The laparoscopic breast-conserving surgery combined with radiofrequency ablation group had more hospitalization expense than the laparoscopic breast-conserving surgery group [(4.1 ± 0.7) ten thousand yuan and (2.3 ± 0.6) ten thousand yuan,P ＜ 0.05].Conclusions Although the laparoscopic breast-conserving surgery combined with radiofrequency ablation group remarkably increased the hospitalization expense because of the utility of the radiofrequency ablation related apparatus,it may provide the probability of shaving more residual tumor cell and may low down the recurrence,especially not rising up the incidence of the post-operative fat liquefaction.Therefore,this surgery method might be one of the potential developments in the minimal-invasive of early stage breast cancer.
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Objective To investigate the technology learning curve of thyroid cancer intraoperative nerve monitoring aiming to reduce the recurrent laryngeal nerve injury complication.Methods Eighty-two cases of thyroid cancer accepted thyroid cancer radical mastectomy or combined radical operation,dissected 147 recurrent laryngeal nerve,used intraoperative nerve monitoring technology,monitored recurrent laryngeal nerve function with four steps method.The recurrent laryngeal nerve injury can be diagnosed when the intraoperative signal decay rate was more than 50％.The damage point and reason can be judged.Results The recurrent laryngeal nerve search time was 0.5 to 2 minutes.The recurrent laryngeal nerve damage rate was 2.7％.Recurrent laryngeal nerve damage cases were all diagnosed during the operation.Recurrent laryngeal nerve damage points were all located in the throat or approaching into the throat.The damage reasons were pull,tumor adhesion,thermal damage and clamp.The technology learning curve of thyroid cancer intraoperative nerve monitoring formatted through search time and injury cases of each group according to the time sequence.Recurrent laryngeal nerve search time and injury cases were obviously downtrend.Conclusions The technology learning curve of thyroid cancer intraoperative nerve monitoring existed.It can be used to protect recurrent laryngeal nerve.
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Objective To investigate the protection of the parathyroid in thyroid cancer operation,reduce the postoperative complications of hypoparathyroidism.Methods Selected 107 cases of thyroid cancer patients from Mar.2013 to Fed.2014 who were underwent thyroid total excision + Ⅵ lymphadenectomy.Identified and preserve in situ of parathyroid according to the typical appearance.Identified the parathyroid on the surface of thyroid and Ⅵ lymph node specimen carefully.Sented a part of the suspected tissue to intraoperative frozen section examination,transplant residual tissue to stemocleidomastoid muscle after confirmed.According to postoperative pathological diagnosis,determined the specimen of thyroid and Ⅵ lymph node with or without removed parathyroid.Monitored serum calcium and symptomatic treatment for 1 to 3 days after operation.Results Error cut rate of parathyroid was 11.4％.In vitro parathyroid autograft rate was 54.4％.Hypocalcemia occurred in 32.7％.Symptomatic hypocalcemia occurred in 16.8％.Permanent hypocalcemia did not happen.Conclusions In thyroid cancer operation,accurate identification of parathyroid is the precondition of preservation in situ and self transplantation,is the effective methods to reduce error removal and decrease postoperative hypocalcemia.
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Objective To explore the clinical significance of occult breast lesions biopsy,determine the operating methods of ultrasound-guided precisie resection of occult breast lesions,improve early diagnosis rate of breast cancer.Methods Forty-eight occult breast lesions of 44 patients were reviewed by localization-needle and skin markers method under ultrasound-guided,and the lesions were removed surgically according to the fixed steps.Results It was confirmed that all the impalpable mammary masses were exactly excised without localization-needle fracture or prolapse through postoperative pathological diagnosis.Breast appearance had no change after the operation.No nipple-areola necrosis occurred.The pathology results showed 4 cases of invasive ductal carcinoma (Ⅰ stage),the incidence rate being 8.3％,and 15 cases of atypical hyperplasia,the incidence rate being 31.3％.The other types were benign disease such as adenosis,intraductal papilloma,fibroadenoma and mammary duct ectasia.Conclusions Ultrasound-guided precise resection of occult breast lesions is a safe and effective diagnosis and treatment method,which needs some surgical skills.It has positive significance in improving breast cancer early diagnosis rate,reducing medical costs and decreasing breast biopsies complications.
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Objective To evaluate the diagnostic value of ultrasonography (USG) and contrast-enhanced computer tomography (CT) for thyroid carcinoma.MethodsThe results of the review of the preoperative CT and those of the original US reports were compared with the histopathologic results in 73 cases of thyroid carcinoma who underwent radical operation and central compartment dissection from November 2009 to November 2011.ResultsThe final diagnostic rate of thyroid carcinoma with USG was 69.9％,CT of that was 80.8％.There were no significant difference between them (P =0.077).The diagnostic rate of metastatic lymph node in the central compartment with USG was 61.6％,positive predictive value was 64.0％,negative predictive value was 60.4％.The diagnostic rate of metastatic lymph node in the central compartment with CT was 67.1％,positive predictive value was 61.7％,negative predictive value was 76.9％.There were not significant difference between them(P =0.848,P =0.152,P =0.489).Conclusion There was no significant difference between USG and CT in The final diagnostic rate of thyroid carcinoma and its lymph node metastasis in the central compartment.
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Objective To evaluate the clinical value and experience of endoscopic thyroidectomy.Methods Thyroidectomy with endoscopic instruments through chest-wall approach was done for 52 patients who had thyroid adenoma nodular goiter or thyroid cancer.We observed the results and complications of these operations.Results All 52 cases of operation were successful with no conversion.There was no nerve damage or postoperative hemorrhage.Average operation duration was (100 ± 22) min.The mean time of hospitalization after operation was (3 ± 0.5) d.Conclusion With the advantages of minimal and hidden incision,sooner recovery and satisfactory cosmetic effect,the endoscopic thyroidectomy will prevail in selected cases in the future.
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ObjectiveTo study the therapeutic effect and feasibility of endoscopic thyroidectomy via breast areola approach. MethodEndoscopic thyroidectomy via breast areola approach was performed in 62 patients, including 16 cases of adenoma, 43 cases of nodular goiter, and 3 cases of thyroid carcinoma.ResultsEndoscopic thyroidectomy was succeeded in 62 patients, 2 cases of cutaneous emphysema, 1 case of light skin bum which diameter was 0.5 cm, 1 case of transient hoarse voice,and 1 case of puncture sinus tract bleeding. There was no converted to open surgery,no hypercapnia, no damage of recurrent laryngeal nerve or parathyriod glands. ConclusionEndoscopic thyroidectomy via breast areola approach is safe and effective,and has good cosmetic results.
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Objective To analyze clinical characteristics of invasive Luminal subtype breast cancer.Methods The data of 162 invasive Luminal subtype breast cancer patients receiving operation in Cancer Hospital of Chinese Academy of Medical Science from January 1 st to September 30th in 2002,were collected and the clinical characteristics,recurrences,metastasis and survivals were retrospectively analyzed.Results The median time of follow-up was 92 months,ranging from 4 to 98 months.41 cases (25.3％,41/162) presented local recurrence or metastasis including 32 cases with metastasis ( 19.8％,32/162),2 cases with local recurrences (1.2％,2/162) and 7 cases with both local recurrence and metastasis (4.3％,7/162) ;Disease-free survival (DFS) and the 5-year DFS were 73.1％ and 79.6％,respectively.27 patients ( 16.7％,27/162) died of breast cancer,the overall survival (OS) and 5-year OS were 82.5％ and 85.3％,respectively.According to Kaplen-Meier survival analysis,tumor size,lymph node status and clinical stage were correlated to overall survival time ( P ＜ 0.05 ) ; and rumor size,lymph node starus,grade,clinical stage and PR status were correlated to disease-free survival time ( P ＜ 0.05 ).By multivariate analysis,TNM stage,PR and PCNA were independent prognostic factors correlated to overall survival time (OR=0.633,95％ CI:0.411 -0.976,P＜0.05; OR =0.823,95％ CI:1.012-3.283,P ＜ 0.05) ; TNM stage and PR was independent prognostic factors correlated to disease-free survival time (OR =3.273,95％ CI:1.719 - 6.232,P ＜ 0.01 ; OR =0.599,95％ CI:0.423 - 0.850,P ＜ 0.01 ).Conclusions In invasive Luminal subtype breast cancers,PR is correlated to fine prognosis,and PCNA is correlated to overall survival time.