Реферат
Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.
Реферат
Objective:To investigate the clinicopathological characteristics of papillary thyroid microcarcinoma in the isthmus (PTMCI) and the independent risk factors of central lymph node metastasis.Methods:58 consecutive patients with PTMCI admitted from Jan. 2016 to Dec. 2018 (isthmus group) were retrospectively analyzed, including 15 males and 43 females,age (42.93±12.69) years old; According to the specific location of papillary thyroid microcarcinoma (PTMC) in isthmus, PTMCI were subdivided into the right PTMCI and the left PT-MCI 67 patients with a single PTMC located in the unilateral lobe were randomly selected as a control (lobe group) , including 13 cases of male and 54 cases of female, age (47.18±11.34) years old. Index included the patient’s age, gender, tumor diameter, TPOAb, aspect ratio, microcalcification, capsular invasion, lymph node metastasis, surgical methods, operation method, and scope of lymph node dissection. SPSS 21.0 software was used for statistical analysis. The quantitative data of normal distribution was expressed as ± s,and the difference between the two groups was compared by chi-square test.The risk factors of CLNM of the isthmus group were analyzed with univariate chi-square test and multivariate Logistic regression analysis.The difference was statistically significant if P<0.05. Results:Compared with PTMC, PTMCI showed a higher rate of capsule invasion ( P=0.003) ,lymph node metastasis ( P=0.049) ,lymph node metastasis in central region ( P=0.033) ,and surgical methods between the two groups were statistically significant ( P<0.05) ;But PTMCI was significantly lower than PTMC in aspect ratio>1 ( P<0.05) . Univariate analysis showed that capsule invasion ( P=0.001) and microcalcification ( P=0.012) were risk factors for PTMCI lymph node metastasis. Multivariate Logistic regression analysis showed that capsule invasion ( P=0.016) and microcalcification ( P=0.046) were independent risk factors for central lymph node metastasis in PTMCI. Conclusions:Compared with PTMC,PTMCI indicates a higher rate of capsular invasion,lymph node metastasis in prelaryngeal and central lymph node;Compared with PTMC, PTMCI indicates a lower rate of aspect ratio>1; Capsule invasion and microcalcification are independent risk factors for central lymph node metastasis in PTMCI. For patients with the right PTMCI or the left PTMCI and also without capsular invasion and calcification,ipsilateral central lymph node dissection should be considered.
Реферат
Objective:To explore the efficacy and safety of escharectomy and skin grafting combined with negative pressure wound treatment in the treatment of patients with deep burn.Methods:A total of 208 deep burn patients who were treated in Haining People's Hospital from May 2018 to May 2019 were selected in the research.They were randomly divided into observation group and control group according to the random digital table method, with 104 cases in each group.The observation group was treated with escharectomy and skin grafting combined with negative pressure wound treatment.The control group was treated with escharectomy and skin grafting combined with traditional pressure bandaging.The general treatment, wound healing rate, changes of serum inflammatory factors before treatment and after treatment for 7 days, and complications of the two groups were compared.Results:The total excellent and good healing rate of the observation group (92.31%) was higher than that of the control group (79.81%) (χ 2=6.772, P<0.05). The granulation growth time [(8.23±2.16)d], wound healing time [(17.64±2.58)d], postoperative pain score[(3.16±1.24)points] and hospitalization time [(22.61±2.47)d] in the observation group were lower than those in the control group [(12.15±2.33)d, (20.25±3.16)d, (5.33±1.27)points and (26.13±2.55)d] ( t=12.582, 6.525, 12.468, 10.111, all P<0.05). At 7 days after treatment, the levels of CRP[(21.12±2.48) ng/L], TNF-α [(3.27±0.38)ng/L], IL-6 [(5.32±1.46)ng/L] and C3a [(12.13±1.62)μg/L] in the observation group were lower than those in the control group [(28.06±2.62)ng/L, (5.13±0.43)ng/L, (6.68±1.51)ng/L and (16.43±1.26)μg/L] ( t=19.618, 33.055, 6.603, 21.367, all P<0.05). The total incidence of complications in the observation group (7.69%) was lower than that in the control group (22.12%) (χ 2=8.529, P<0.05). Conclusion:Escharectomy and skin grafting combined with negative pressure can improve the wound healing rate, improve the body's inflammatory response, shorten the recovery time, reduce the occurrence of complications and has good safety.
Реферат
Objective Hypothyroidism(HypoPT) is one of the most common complications of thyroid reoperation,and hypocalcemia caused by HypoPT is a difficult problem in clinical practice.This study aims to investigate the risk factors for hypoealcemia after reoperation of thyroid cancer.Methods Data of 106 patients who underwent reoperation for thyroid cancer from 2013 to 2018 were retrospectively analyzed.According to the parathyroid area involved in the reoperation,the reoperation was graded:low-risk group,intermediate-risk group and high-risk group.Parathyroid hormone(PTH) and total calcium(Ca) levels were monitored at 12 to 24 hours after surgery.The follow-up period was at least 6 months.The PTH cut-off values of postoperative hypocalcemia were analyzed by ROC curve.The chi-square test and logistic regression analysis were used to analyze the risk factors of postoperative hypocalcemia.Results The incidence of transient HypoPT after reoperation was 35％,and the permanent HypoPT was 1.9％.The grade of reoperation was positively correlated with postoperative HypoPT.The ROC curve showed that the PTH cut-off values of postoperative hypocalcemia was 15 pg/ml and area under curve(AUC) was 0.636(95％ CI:0.530-0.742,P＜0.017).Univariate and multivariate analysis showed that reoperation grade and postoperative PTH＜15 pg/ml were independent risk factors for postoperative hypocalcemia.Conclusion The grade of reoperation and postoperative PTH value ＜15 pg/ml can predict postoperative hypocalcemia.