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Objective:To investigate the feasibility and clinical significance of near-infrared fluorescence positive imaging combined with intraoperative rapid parathyroid hormone (PTH) determination in identification and function protection of the parathyroid gland during thyroidectomy.Methods:According to the inclusion and exclusion criteria, patients in the Affiliated Lihuili Hospital of Ningbo University, who needed bilateral thyroidecto-my and central lymph node dissection due to suspected bilateral thyroid cancer from Mar. 2020 to Oct. 2020 were selected for a prospective clinical study. They were randomly divided into the study group (near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination) and the control group (intraoperative experience identification) . The number of parathyroid glands found during operation, PTH before and after the operation, blood calcium, blood phosphorus, the presence of parathyroid tissues in routine pathological section examinations, and postoperative symptoms were collected. SPSS 25.0 statistical software was used for analysis, the measurement data were expressed by mean±standard deviation ( ± s) , t test was used for comparison between groups, and χ2 test was used for counting date. Results:In the study group of 33 cases, 135 suspicious parathyroid glands were exhibited during operation, with an average of (4.09±0.52) ; Hand and foot numbness occurred in 1 case (3.03%) ; On the 1st after the operation, PTH was (23.68±9.48) ng/L. In the control group of 31 cases, 109 parathyroid glands were identified by naked eyes, with an average of (3.52±0.63) ; Hand and foot numbness occurred in 6 cases (19.35%) ; On the 1st after the operation, PTH was (17.93±11.58) ng/L. The differences were statistically significant ( P<0.05) . But no statistical significance was found in operation duration (79.45±30.18) min, postoperative hospitalization days (5.85±2.27) days, PTH (27.10±9.80, 33.08±10.21) ng/L, blood calcium (2.11±0.10,2.25±0.09) mmol/L, and blood phosphorus (1.20±0.20,1.15±0.12) mmol/L on the 3rd day and the 6th month after the operation. Conclusion:Near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination can improve the recognition rate of the parathyroid gland and reduce postoperative complications, which is a safe, effective and rapid method for intraoperative parathyroid gland recognition.
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Objective:To evaluate the clinical efficacy of endoscope assisted supraclavicular thyroidectomy and lymph node dissection through the sternocleidomastoid muscular approach (ELDS) .Methods:Clinical data of 40 patients undergoing ELDS and 40 patients who had open surgery (open group) by same team admitted to Ningbo Medical Center Lihuili Hospital from Jan. 2021 to Jan. 2022 were retrospectively analyzed. The intraoperative and postoperative outcomes and follow-up were observed situation. The intraoperative situation, the number of lymph nodes dissected, postoperative outcomes and scar healing satisfaction were observed. SPSS 20.0 software was employed to carry out statistical analysis, the measurement date were compared with t-test, and the counting date were analyzed by χ2 test. Results:There was no significant differences in the two groups with respect to the number of lymph nodes dissected (ELDS group: 30.5±9.8, open group: 29.9±9.0) . The surgical injury in ELDS group were significantly smaller than those in open group, and the operation time was significantly higher in open group (ELDS group: 95.2±12.0min, open group: 82.3±13.9min, P<0.05) . In postoperative follow-up, there were significant differences between the two groups in swallowing impairment, anterior cervical pressure and scar satisfaction (ELDS group: 4.45±1.82, open group: 6.03±1.47, P<0.05) , and the lateral approach group was superior to open group, but there were no significant differences in parathyroidism or recurrent laryngeal nerve injury ( P>0.05) . Conclusions:ELDS has the advantages of good cosmetic effect, less postoperative anterior cervical discomfort, less postoperative complications, and good lymph node dissection effect. The operation is safe and feasible, and has obvious advantages over traditional operation.
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Objective To determine the clinicopathological risk factors and reliable biochemical predictors of the development of hypoparathyroidism after total thyroidectomy plus central compartment node dissection in papillary thyroid carcinoma (PTC).Methods A study was performed on 93 patients who underwent a total thyroidectomy with central compartment node dissection due to PTC.The rate of hypoparathyroidism was calculated.We evaluated the correlations between hypoparathyroidism and clinicopathological factors by chi-square test and logistic regression model for multivariate analysis.The prediction value of PTH and serum calcium level was assessed by a 2×2 contingency table and ROC curve analysis.Results Postoperative hypoparathyroidism was found in 46 patients (49.5％) and 2 with permanent hypoparathyroidism.Univariate analysis showed that tumor size (P=0.034),perithyroidal extension (P=0.003),bilateral cancer(P=0.045)and bilateral central neck dissection (P=0.028)were risk factors for postoperative hypoparathyroidism in patients with PTC.Multivariate analysis showed that perithyroidal extension (P=0.003) and bilateral central neck dissection(P=0.044)were independent risk factors for postoperative hypoparathyroidism in patients with PTC.ROC curve analysis showed that PTH level in the first after operation played significant roles in predicting hypoparathyroidism(AUC 0.875).Conclusions Hypoparathyroidism is the most common complication after total/near-total thyroidectomy.Perithyroidal extension and bilateral central neck dissection are the important risk factors of hypoparathyroidism.The level of PTH is a reliable and early predictive indicator of postoperative hypoparathyroidism.
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Objective To investigate the efficacy and safety of trastuzumab combined with docetaxel chemotherapy in the treatment of stage Ⅲ breast cancer.Methods 150 cases of stage Ⅲ breast cancer patients from October 2013 to September 2015 in our hospital were selected and randomly divided into experimental group and control group,75 cases in each group,the control group were treated with cyclophosphamide and doxorubicin treatment,experimental group were treated with trastuzumab combined with docetaxel chemotherapy.To 21 days for a course of treatment,all patients were treated three courses.The levels of serum C reactive protein(C-reactive protein,CRP),the total effective rate and the incidence of adverse reactions in two groups before and after treatment were compared.Results After treatment,the level of serum CRP in the two groups decreased significantly,the difference was statistically significant(P<0.05),the CRP levels of serum in experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05),the clinical total effective rate is higher,the difference was statistically significant(P<0.05),the incidence rate of adverse reaction was lower,the difference was statistically significant(P<0.05).Conclusion Trastuzumab combined with docetaxel chemotherapy can effectively reduce the inflammatory response in patients with stage Ⅲ breast cancer,improve clinical efficacy,and effectively reduce the adverse reactions of patients.
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10.3969/j.issn.1007-3969.2013.05.007