摘要
Surgery is an important means of clinical treatment of thyroid diseases. For thyroid diseases that have failed conservative treatment, surgical treatment is recommended. With the maturation of thyroid endoscopy technology and the increasing demand for cosmetic surgery, more and more thyroid endoscopic surgeries are being performed. Endoscopic thyroid surgery has the advantages of small incision, less bleeding, less postoperative complications, less scar tissue, and so on, which has been clinically recognized and approved. Although endoscopic surgery has achieved remarkable results in the treatment of thyroid diseases, how to effectively protect the parathyroid gland during surgery and avoid hypothyroidism is one of the difficulties that surgeons pay attention to. In this paper, the identification and protection techniques of the parathyroid gland during endoscopic thyroid surgery were analyzed, and summarized, in order to provide a reference for improving the protection techniques of the parathyroid gland during endoscopic thyroid surgery.
摘要
Objective:To analyze the risk factors for central lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC) aged 55 years and above, and to construct a predictive model with columnar graph.Methods:This retrospective study included 406 PTC patients aged 55 and above, treated at the First Affiliated Hospital of Zhengzhou University from Nov. 2019 to Feb. 2022. Data on demographic characteristics, disease features, and laboratory test results were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for CLNM and develop a clinical prediction model and nomogram.Results:The study involved 406 patients, divided into a modeling group (285 patients) and a validation group (121 patients). The predictive model identified independent risk factors for CLNM. In the modeling group, the model demonstrated a ROC AUC of 0.769, with 82.6% sensitivity, 63.0% specificity, and 67.7% accuracy. The validation group showed 66.7% sensitivity, 74.5% specificity, and 72.7% accuracy, with an AUC of 0.760. Hosmer-Lemeshow tests indicated good fit in both groups. Decision curve analysis confirmed the model's clinical decision-making value, showing better performance than traditional strategies and good generalizability and reliability.Conclusions:Sex, maximum tumor diameter, bilateral involvement of thyroid lobes, clinically evident cervical lymph nodes, and local invasion are independent predictive factors for CLNM in patients over 55 with papillary thyroid carcinoma (PTC). A clinical risk stratification nomogram model based on these risk factors demonstrates good predictive performance.
摘要
Objective:To investigate the discomfort of chest wall approach area in patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach (GUA), and to analyze its influencing factors. To provide a basis for the development of targeted improvement measures.Methods:A total of 153 patients with GUA from May. 2023 to Aug. 2023 in the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University were selected as the study subjects. The general information questionnaire was collected one day before operation, the pain scales were assessed one day and three days after operation, and the pain and numbness scales were assessed one month after operation. The t test or χ2 test was used for comparison of baseline data between groups according to different types of variables. The patients were divided into two groups: less than moderate pain group (two postoperative average VAS scores<4) and more than moderate pain group (two postoperative average VAS scores ≥4). Mild numbness group (postoperative VAS score<4) ; Moderate and severe numbness group (postoperative VAS score ≥4). Multivariate binary Logistic regression was performed with pain discomfort and numbness discomfort as dependent variables to find possible influencing factors. Results:A total of 153 valid questionnaires were collected. There were 125 patients in the moderate pain group; There were 28 patients in the moderate and above pain group. There were 94 patients in the mild numbness group. There were 59 patients in the moderate to severe numbness group. Multivariate binary Logistic regression results showed that, exercise habits ( OR=0.07 95% CI=0.006, 0.409), operation duration ( OR=1.026 95% CI=1.001, 1.054), total drainage volume ( OR=1.122 95% CI=1.07, P<0.05), 1.198), and drainage tube indwelling time ( OR=0.012 95% CI=0.0, 0.187) had an impact on the discomfort of the chest wall approach area, and the difference was statistically significant ( P<0.05). Gender, BMI, marital status, education, occupation, handed-side surgery, handed-side axillary surgery, smokess and alcohol history, intraoperative blood loss, and length of hospital stay had no effect on the discomfort of chest wall approach area, and the difference was not statistically significant ( P>0.05) . Conclusion:Exercise habits, operation duration, total drainage volume, and drainage duration are independent predictors of discomfort in GUA patients.
摘要
This article summarizes the current status of the application of ablation in thyroid tumors with reference to relevant guidelines and expert consensus.The application of ablation in treating benign thyroid tumors has gradually gained maturity in recent years,but the application in malignant thyroid tumors is controversial.Currently,some clinical practices are constantly trying to broaden the application of ablation in treating malignant thyroid tumors.Ablation,which is mainly applied to benign thyroid tumors,has good prognosis and high patient satisfaction.Since this technique cannot avoid the potential recurrence risk of malignant thyroid tumors or eradicate local or distant occult metastases,the indications for the use of ablation in malignant thyroid tumors should be strictly controlled.
摘要
Objective To analyze the clinical characteristics of C-TI-RADS 3 thyroid nodules with a diameter greater than 2 cm and explore their correlation with gender,nodule ingredient,contralateral cancer presence,diffuse echo changes,TPOAB and TGAB.Methods A retrospective analysis was made on the clinical and pathological information of 94 patients with thyroid nodules who were admitted to our department from September 2022 to March 2023.All the patients underwent cytological and/or histopathological examinations.The proportions of TBS I category,benign tumors,low-risk tumors,and malignant tumors were calculated.The proportion of TBS type Ⅰ,benign tumors,low-risk tumors,and malignant tumors was quantified.Subsequently,a comparative analysis was conducted among the benign,low-risk,and malignant groups in terms of clinical characteristics including gender distribution,nodule composition,contralateral cancer occurrence,diffuse echo changes presence,as well as TPOAB and TGAB levels.Results Seven cases in TBS I category were excluded.Among the remaining 87 cases with confirmed pathology results for nodules,there were 72 benign cases(38 cytology cases and 34 histology cases),5 low-risk thyroid tumors(2 cytology cases and 3 histology cases),10 malignant cases(8 PTC cases,1 FTC case,and 1 MTC case).There was a significant difference in nodule ingredient(cystic/solid)between different pathological types(x2=10.369,P=0.006).However,no statistical significance was found in terms of gender,diffuse echo changes,contralateral cancer presence,TPOAB or TGAB(P＞0.05).Further analysis showed that the proportion of solid component was higher in low-risk tumors than in benign nodules(x2=9.571,P=0.002).No statistical significance was found between malignant nodules and low-risk nodules(x2=2.143,P=0.143),or between malignant nodules and benign nodules(x2=2.165,P=0.141).Conclusion Although TI-RADS 3 nodules are generally considered as potentially benign according to various versions of thyroid imaging reporting and data system,malignant nodules still account for a certain proportion.Attention should be paid to thyroid nodules with a typical ultrasonic signs,such as cystic nodules,thyroid follicular tumors and medullary thyroid carcinoma.Ultrasound guided fine needle aspiration cytopathology is necessary for evaluating benign and malignant nodules.It is necessary to pay attention to unsatisfactory or undiagnosable specimens to improve the accuracy of diagnosis.
摘要
As the elderly population continues to rise, the issue of disease diagnosis and treatment in the elderly population is becoming a hot topic of concern. Differentiated thyroid cancer is the most common endocrine malignancy in the world, and patients with differentiated thyroid cancer in the elderly have a worse clinical prognosis and higher risk of recurrence and metastasis. Moreover, due to the special characteristics and complexity of the elderly population, patients with differentiated thyroid cancer in the advanced age group have special features in terms of morbidity, preoperative diagnosis, treatment options, and postoperative management compared with other populations. This article reviews the current status of diagnosis and treatment of differentiated thyroid cancer in the elderly, taking into account the findings and opinions of domestic and international studies.
摘要
With the gradual popularization of high-resolution ultrasound, the wide application of fine-needle aspiration biopsy technology under ultrasound guidance, and the rapid development of molecular marker detection technology, the detection rate of papillary thyroid microcarcinoma (PTMC) has increased year by year.The main clinical treatment method for PTMC is surgery or active surveillance. In recent years, with the good application of thermal ablation technology in the treatment of liver cancer, benign thyroid nodules and other tumors, many scholars at home and abroad advocate applying this technology in the treatment of PTMC.However, there is still a lack of multicenter, prospective long-term studies with large sample size to confirm the safety and effectiveness.Therefore, it is highly controversial whether thermal ablation should be applied to the initial treatment of PTMC.This paper will comment on this hot issue.
摘要
Anaplastic thyroid cancer (ATC) is a rare malignancy, accounting for 1%-2% of all thyroid cancers, however, ATC accounts for the majority of deaths from thyroid cancer. Currently, the main comprehensive treatments are surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy. Based on the latest American Thyroid Association guidelines and the related literatures, we summarize the most reasonable and effective therapeutic strategies to improve the survival rate of patients with ATC as well as the quality of life.
摘要
As a treatment option for cancer, thermal ablation has satisfactory effects on many types of solid tumors (such as liver and renal cancers). However, its clinical applications for the treatment of thyroid nodules and metastatic cervical lymph nodes are still under debate both in China and abroad. In 2015, the “Zhejiang Expert consensus on thermal ablation for thyroid benign nodules, microcarcinoma, and metastatic cervical lymph nodes (2015 edition),” was released by the Thyroid Cancer Committee of Zhejiang Anti-Cancer Association, China. To further standardize the application of thermal ablation for thyroid tumors, the Thyroid Tumor Ablation Experts Group of Chinese Medical Doctor Association has organized many seminars and finally produced a consensus to formulate the “Expert consensus workshop report: Guidelines for thermal ablation of thyroid tumors (2019 edition).”
摘要
In recent years, the incidence of thyroid cancer has increased significantly. The prognosis of early thyroid cancer is relatively good, which makes early diagnosis and standardized treatment become the key. This article will discuss early prevention methods, health screening, early diagnosis standards, standardized treatment and medical services for thyroid cancer, and summarize the progress made in the early prevention and treatment of thyroid cancer in my country and the problems that that need further improvement. To provide healthy protection for the building of a moderately prosperous society in all respects.
摘要
Objective:To investigate the potential risk factors of the tumor abnormal protein (TAP) in papillary thyroid carcinoma (PTC) and analyze the clinical significance of TAP.Methods:The clinical data of 792 patients who underwent thyroid surgery in the thyroid surgery department of the First Affiliated Hospital of Zhengzhou University from Jun. 2018 to Jun. 2019 was collected, of whom 564 were PTC patients and 228 were benign thyroid tumor patients. Patients were divided into two groups by postoperative pathology: PTC group and thyroid benign tumor group. The potential risk factors the TAP in PTC were analyzed by univariate and multivariate Logistic regression analysis, and then the diagnostic value of TAP for PTC was assessed by ROC curve analysis.Results:Multivariate analysis showed that tumor maximum diameter (≥1.0 cm) ( OR:1.555; 95% CI: 1.031~2.344, P=0.035) and multifocal tumor ( OR:1.789; 95% CI: 1.098~2.916, P=0.019) were risk factors for elevation of TAP. Gender, age, body weight, extracapsular extension of cancer, invasive growth of cancer, Hashimoto's thyroiditis, central lymph node metastasis, lateral lymph node metastasis, and BrafV600E mutation were not associated with TAP ( P>0.05) . TAP in patients with PTC was significantly higher than that in patients with benign thyroid tumors[ (122.36±49.37) μm 2 vs (105.04±40.61) μm 2, P<0.001]. The sensitivity and specificity of TAP in diagnosing PTC were 78.90% and 40.35%, respectively. Conclusions:Tumor maximum diameter (≥1.0 cm) and multifocal tumor in PTC were risk factors for elevation of TAP. TAP has certain clinical value in differentiating PTC and thyroid benign tumor, which could be used as an auxiliary indicator.
摘要
Objective To investigate the application effect of glucocorticoids on perioperative period of complicated thyroid cancer surgery.Methods All patients were from Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University.A total of 373 patients with thyroid surgery longer than 3 hours from Jan.2017 to Dec.2017 were as the control group.386 patients with thyroid surgery longer than 3 hours from Jan.2018 to Dec.2018 were included in the observation group.Patients in the control group were not treated with glucocorticoids during perioperative period,and patients in the observation group were treated with glucocorticoids during perioperative period.Several factors were compared between the two groups,including postoperative drain removal time,postoperative hospitalization time,postoperative complication rate,the incidence of postoperative infection and delayed wound healing.Results The postoperative drain removal time [(2.5±0.42) vs (3.2±0.63),t=25.72,P＜0.001)] and the postoperative hospitalization time [(3.6±0.57) vs (4.8±0.71),t=18.07,P＜0.001)] in the observation group was shorter than in the control group.The incidence of complications in the observation group was lower than that in the control group,such as postoperative coarse respiratory sounds (3.1％ vs 6.7％,x2=4.790,P=0.029),mild to moderate dyspnea (1.0％ vs 3.2％,x2=4.191,P=0.041),cough (8.3％ vs 14.2％,x2=5.366,P=0.021),sore throat (4.9％ vs 9.4％,x2=4.952,P=0.026),headache (8.8％ vs 11.5％,x2=4.392,P=0.036) and nausea (3.6％ vs 8.6％,x2=7.235,P=0.007),however,the incidence of hoarseness between the two groups was statistically significant (1.6％ vs 2.1％,x2=0.352,P=0.553).There was no significant difference in the incidence of postoperative infection (2 cases vs 1 case,x2=0.299,P=0.585) or delayed wound healing (3 cases vs 3 cases,x2=0.002,P=0.964) between the two groups.Conclusion The application of glucocorticoids in patients with complicated thyroid cancer surgery can effectively reduce the incidence of complications and shorten the hospitalization time of patients.
摘要
Objective To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC),and provide a basis for the individualized surgical procedure.Methods Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,from January 2016 to June 2018,including 206 males and 734 females,with a gender ratio of 1.0∶ 3.6.Age ranged from 18 to 78,with an average of (45.5± 10.6) years.The correlation between gender,age,cancer size,muhifocality,BRAFV600E gene mutation,complicated with hashimoto's thyroiditis,extrathyroidal extension and lymph node metastasis were analyzed.SPSS 21.0 software was used for statistical analysis.Chi-square test or rank sum test was adopted for comparison between groups,and logistic regression analysis was adopted for multivariate analysis.Results There were 397 (42.2％) patients with central lymph node metastasis (CLNM) and 104 (11.1％) patients with lateral lymph node metastasis (LLNM).Univariate analysis showed that male,age ＜ 55 years old (x2 =24.485,P ＜ 0.001),bilateral cancer foci (x2 =8.100,P =0.004),larger length-diameter (Z =-0.016,P ＜0.001),and BRAFV600E gene mutation (x2 =4.918,P =0.027) had a higher CLNM positive proportion,and LLNM positive proportion was higher in male (x2 =6.584,P =0.010),bilateral cancer foci (x2 =26.669,P ＜0.001),larger length-diameter (Z=-4.991,P ＜0.001),extra-glandular invasion (x2 =16.862,P ＜0.001).Multivariate logistic regression analysis showed that gender (OR =2.091,P ＜0.001),age (OR =1.551,P =0.010),cancer lesion length (OR =5.285,P ＜ 0.001) and BRAFV600E gene mutation (OR =1.648,P =0.038) were independent risk factors for CLNM in PTMC patients.Gender (OR =1.657,P =0.032),bilateral lesion (OR =2.610,P ＜ 0.001),tumor length diameter (OR =7.420,P ＜ 0.001) and extrathyroidal extension (OR =2.611,P =0.005) were independent risk factors for LLNM.The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm,respectively.Conclusions For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis,preventive dissection of central lymph nodes was recommended,and preventive dissection of lateral lymph nodes should also be comprehensively considered,by evaluating the extrathyroidal extension.
摘要
Objective@#To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and provide a basis for the individualized surgical procedure.@*Methods@#Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, from January 2016 to June 2018, including 206 males and 734 females, with a gender ratio of 1.0∶3.6. Age ranged from 18 to 78, with an average of (45.5±10.6) years. The correlation between gender, age, cancer size, multifocality, BRAFV600E gene mutation, complicated with hashimoto′s thyroiditis, extrathyroidal extension and lymph node metastasis were analyzed. SPSS 21.0 software was used for statistical analysis. Chi-square test or rank sum test was adopted for comparison between groups, and logistic regression analysis was adopted for multivariate analysis.@*Results@#There were 397 (42.2%) patients with central lymph node metastasis (CLNM) and 104 (11.1%) patients with lateral lymph node metastasis (LLNM). Univariate analysis showed that male, age < 55 years old (χ2=24.485, P<0.001), bilateral cancer foci (χ2=8.100, P=0.004), larger length-diameter (Z=-0.016, P<0.001), and BRAFV600E gene mutation (χ2= 4.918, P=0.027) had a higher CLNM positive proportion, and LLNM positive proportion was higher in male (χ2=6.584, P=0.010), bilateral cancer foci (χ2=26.669, P<0.001), larger length-diameter (Z=-4.991, P<0.001), extra-glandular invasion (χ2=16.862, P<0.001) . Multivariate logistic regression analysis showed that gender (OR=2.091, P<0.001), age (OR=1.551, P=0.010), cancer lesion length (OR=5.285, P<0.001) and BRAFV600E gene mutation (OR=1.648, P=0.038) were independent risk factors for CLNM in PTMC patients. Gender (OR=1.657, P=0.032), bilateral lesion (OR=2.610, P<0.001), tumor length diameter (OR=7.420, P<0.001) and extrathyroidal extension (OR=2.611, P=0.005) were independent risk factors for LLNM. The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm, respectively.@*Conclusions@#For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis, preventive dissection of central lymph nodes was recommended, and preventive dissection of lateral lymph nodes should also be comprehensively considered, by evaluating the extrathyroidal extension.
摘要
Objective To evaluate the relationship between clinicopathological features and central lymph nodes metastasis in patients with papillary thyroid microcarcinoma (PTMC),and aim to provide an appropriate operation in clinic.Methods The clinical data of 536 patients undergoing surgical treatment in Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2017,who had pathologically confirmed popillary thyroid microcarcinoma (PTMC) were retrospectively analyzed.Thyroidectomy and isthmectomy with central compartment neck dissection were performed in all patients.The patients were divided into two groups according to whether there existed central lymph node metastasis,and compared the differences of gender,age,number of cancer lesions,tumor breakthrough envelope,BRAFV600E gene mutation,and tumor maximum diameter in the central lymph node metastasis,respectively,by t-test x2-test.Univariate logistic regression analysis and multivariate binary logistic regression analysis were conducted to find risky factors.Results There existed difference between two groups by completing the gender,age,the BRAFV600E gene mutation and maximal tumor diameter(P ＜ 0.05).Univariate logistic regression analysis indicated that gender (P =0.046),age (P ＜ 0.01),maximal tumor diameter(P ＜0.01) and the BRAFV600E gene mutation(P =0.016) were significant predictors for central lymph nodes metastasis.And multivariate binary logistic regression analysis revealed that the rate of lymph node metastasis significantly increased in cases of larger tumor diameter(P ＜0.01),BRAFV600E gene mutation(P =0.035) and ageing below 45 years old (P ＜ 0.01).Conclusions The treatment for central lymph node metastasis of PTMC should be different considering elements including BRAF600E gene mutation prophylactic,ageing below 45 years old and larger tumor diameter.Therefore central lymphadenectomy should be performed when the primary lesion was resected.
摘要
Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for external branch of superior laryngeal nerve(EBSLN).Methods From Jan.2017 to Jun.2017,138 patients undergoing thyroidectomy were randomly divided into monitor group (n=69) and the control group (n=69).The monitor group were used IONM for EBSLN,while the control group were used conventional area protection.Results The overall incidence of EBSLN injury was 1.4％(1/69) in the monitor group,and the overall incidence of EBSLN injury was 11.6％(8/69) in the control group.There was statistical significance between the two groups.Conclusion The application of IONM in thyroidectomy can exactly identify EBSLN,and reduce the possibility of EBSLN injury remarkably.
摘要
Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery.Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed,and the patients with preoperatively known high-risk characteristics were excluded.One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines.The proportion of patients who need secondary surgery was estimated basing on pathological characteristics.Result In this group,49％ patients would have to undergo a secondary surgery if they took lobectomy as the initial operation.Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery.Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation.
摘要
Recurrent laryngeal nerve damage is one of the common complications in thyroidectomy.With the wide application of ultrasonic scalpel,intraoperative nuromonitoring,endoscopic thyroidectomy,meticulous dissection technique,the surgery methods has changed obviously,in the same time,new problems to protect recurrent laryngeal nerve in thyroidectomy has appeared.To be familiar with the anatomical characteristics of recurrent laryngeal nerve and to be skilled in using the new technique and new device are the keys to protect recurrent laryngeal nerve under new technologies and advanced conceptions.
摘要
Recurrent laryngeal nerve damage is one of the common complications in thyroidectomy.With the wide application of ultrasonic scalpel,intraoperative nuromonitoring,endoscopic thyroidectomy,meticulous dissection technique,the surgery methods has changed obviously,in the same time,new problems to protect recurrent laryngeal nerve in thyroidectomy has appeared.To be familiar with the anatomical characteristics of recurrent laryngeal nerve and to be skilled in using the new technique and new device are the keys to protect recurrent laryngeal nerve under new technologies and advanced conceptions.
摘要
Objective To clarify the role of BRAFV600E and TERT promoter mutations in cervical lymph node metastasis in papillary thyroid carcinoma.Methods The data of 432 patients with thyroid papillary carcinoma who underwent surgery from February 2017 to September 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The mutation of BRAFV600E and TERT promoter was detected by Sanger sequencing.The effect of BRAFV600E and TERT on cervical lymph node metastasis in patients with papillary thyroid carcinoma was analyzed by Chi-square test.Results The mutation rates of BRAFV600E and TERT promoter were 77.8％ (336/ 432) and 5.3％ (23/432) respectively in 432 papillary thyroid carcinoma patients.The probability of cervical lymph node metastasis in patients with BRAFV600E mutation was significantly higher than that in non-mutation patients (P ＜ 0.05).The probability of cervical lymph node metastasis in patients with TERT promoter mutation was significantly higher than that in non-mutated patients (P ＜ 0.05).Patients with both BRAFV600E and TERT promotermutation had a significantly higher incidence of cervical lymph node metastases than patients with the BRAFV600E mutation alone (P ＜ 0.05).Conclusions The mutations of BRAFV600E and TERT promoter are closely relevant to the occurrence of cervical lymph node metastasis in papillary thyroid carcinoma.Preoperative fine-needle aspiration cytology and postoperative routine pathological molecular diagnosis can help clinicians to develop a more rational treatment strategy,and a more accurate assessment of the risk of relapse.