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Objective:To investigate the efficacy and safety of thoracic duct repair in the treatment of iatrogenic thoracic duct injury in thyroid surgery.Methods:Clinical data of 2 759 cases with lymph nodes metastasis from papillary thyroid carcinomas at two tertiary referral academic medical centers, viz. Tongji Hospital of Huazhong University of Science and Technology and Zhongnan Hospital of Wuhan University were retrospectively analyzed, of which 69 cases encountered injured thoracic duct. Thirty patients received thoracic duct ligation (ligation group) before Jun. 2016, and thirty-nine with direct suture repair of lacerated duct (repair group). Age, sex, cervical clearance surgery, lymph node dissection, lymph node metastasis, whether lymph nodes were invaded extracapsular, chest catheter injection into venous points, and operation time were recorded.Results:In the thoracic duct direct suture repair group, 39 patients with a mean age of (43.2±9.3) successfully performed intraoperative thoracic duct sutures and only one patient developed CL postoperatively. In the thoracic duct ligation group, 30 ducts with a mean age of (49.5±10.0) were successfully ligated during the operation, and 5 (16.7 %) still developed CL after operations, with the highest daily drainage volume of more than 500 ml, and the median duration of chylous leakage of 3 days. The incidence of CL in the thoracic duct direct suture repair group was significantly lower than that in the ligation group (0 vs 16.7%, P=0.013), and the length of hospital stay in the repair group was also significantly shorter (6.1 (6.0,6.5) vs 10.0 (9.0,10.0) day, Z=-7.21, P=0.014) .There was no significant difference in operation time between the two groups (110.9±8.7 vs 109.3±7.9, t=0.82, P=0.421) . Conclusion:Compared with thoracic duct ligation, thoracic duct direct suture repair in patients with intraoperative thoracic duct injury may be an effective method to reduce postoperative CL.
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The novel coronavirus disease-2019 (COVID-19) has been spreading around the world rapidly and declared as a pandemic by WHO. Here, we compared the ABO blood group distribution in 2,173 patients with COVID-19 confirmed by SARS-CoV-2 test from three hospitals in Wuhan and Shenzhen, China with that in normal people from the corresponding regions. The results showed that blood group A was associated with a higher risk for acquiring COVID-19 compared with non-A blood groups, whereas blood group O was associated with a lower risk for the infection compared with non-O blood groups. This is the first observation of an association between the ABO blood type and COVID-19. It should be emphasized, however, that this is an early study with limitations. It would be premature to use this study to guide clinical practice at this time, but it should encourage further investigation of the relationship between the ABO blood group and the COVID-19 susceptibility.
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Significant progress has been made toward understanding the tumorigenic role and clinical significance of the T1799A B-type Raf kinase(BRAF)mutation in papillary thyroid cancer(PTC). With these advances, it has become clearer that BRAF mutation will likely have significant impact on the clinical management.