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1.
Zhonghua Zhong Liu Za Zhi ; 43(2): 176-179, 2021 Feb 23.
Artigo em Chinês | MEDLINE | ID: mdl-33601481

RESUMO

As the primary surgical procedure of treating and preventing cervical lymph node metastasis in head and neck cancers, neck dissection (ND) have increasingly becoming standardized and reasonable since the past hundred years. However, the preoperative uncertainty of cervical lymph node metastasis for patient with head neck cancer, whether perform ND and the dissection region often confuse the surgeons. Provide a currently standardized ND operation manner according to the metastatic characteristics and operative wound degree as a reference to surgeons may facilitate the therapeutic and prevent effects on patients with head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço , Esvaziamento Cervical , Dissecação , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Linfonodos/cirurgia , Metástase Linfática , Pescoço
2.
Artigo em Chinês | MEDLINE | ID: mdl-33540995

RESUMO

Objective:To construct and verify a model of lymph node metastasis in cN0 stage thyroid micropapillary carcinoma. To explore the significance of thyroid gland lobectomy combined with prophylactic zone Ⅵ lymph node dissection in cN0 stage thyroid micropapillary carcinoma surgery. Methods:The clinical data of 670 patients with cN0 stage thyroid micropapillary carcinoma and area Ⅵ lymph node dissection were collected. All patients underwent the affected thyroid gland lobe±isthmus resection+ area Ⅵ lymphadenectomy on the same side. Logistic regression model was constructed by gender, age, size of thyroid papillary carcinoma, whether it was multifocal, whether it was encroaching on the membrane, and whether the lymph nodes in the central area were metastasized, and displayed by nomogram. Discrimination and prediction accuracy were evaluated by C-index, calibration curve and ROC curve. An internal validation group was used to test the fitted model. Analyze the lymph node metastasis trend according to the largest tumor diameter. Follow-up analysis of the reoperation was conducted to evaluate the effect of initial surgery. Results:The rate of lymph node metastasis in area Ⅵ was 36.7%. Multiple regression analysis included three variables. The largest tumor diameter(P<0.001), male(P<0.001) and young(P<0.001) were the main independent risk factors for lymph node metastasis. Conclusion:The reoperation rate of thyroid gland lobectomy combined with prophylactic zone Ⅵ lymph node dissection was low, and this surgical method might be safe and reliable for the treatment of cN0 stage thyroid micropapillary carcinoma, and it is worthy of promotion.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Humanos , Linfonodos , Metástase Linfática , Masculino , Esvaziamento Cervical , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
3.
Medicine (Baltimore) ; 100(4): e23866, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530180

RESUMO

INTRODUCTION: Metastasis of a papillary thyroid microcarcinoma (PTMC) in the lateral neck is characterized primarily by solid lymphadenopathy, although some cases may rarely present with a cervical cystic mass. We report a case of lateral cervical lymph node metastases of PTMC that appeared as a cystic lymphangioma of the lateral neck. PATIENT CONCERNS: A 55-year-old man with a painless egg-sized mass in the right side of the neck that had been present for 1 month underwent physical examination, ultrasonography, computed tomography (CT), fine needle aspiration biopsy (FNAB), and intraoperative fast-frozen pathological examination, which indicated that the cystic masses in the neck were benign. However, the final pathology report identified the lateral neck masses as lymph node metastases of thyroid carcinoma. DIAGNOSIS: The patient was diagnosed with PTMC of the right lobe of the thyroid gland with lateral neck metastases. INTERVENTIONS: The patient underwent right cervical neck dissection together with a right thyroidectomy, followed by levothyroxine therapy and routine follow-up. OUTCOMES: No postoperative complications were reported, and the thyroid-stimulating hormone inhibition target was <0.1 mmol/L; there was no detectable tumor recurrence on routine clinical follow-up for up to 16 months. CONCLUSIONS: This case report emphasizes the need to consider cervical lymph node metastases of thyroid carcinoma in the differential diagnosis for patients with large, multiple, simple cystic neck masses.


Assuntos
Carcinoma Papilar/patologia , Neoplasias de Cabeça e Pescoço/secundário , Linfangioma/patologia , Metástase Linfática , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/tratamento farmacológico , Carcinoma Papilar/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Terapia de Reposição Hormonal , Humanos , Linfangioma/cirurgia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Tiroxina/uso terapêutico
4.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408107

RESUMO

A 38-year-old male patient presented to the ear, nose and throat department with shortness of breath over last 2 months. The CT scan of the neck and chest revealed a 3.3×3 cm tumour behind the right thyroid lobe extending into the tracheo-oesophageal (TO) groove with tracheal compression. The ultrasound scan of the neck and targeted fine needle aspiration followed by core biopsy raised a suspicion of Hodgkin's lymphoma. The patient underwent a right hemithyroidectomy and incisional biopsy of the right TO groove tumour. The histology confirmed a Hasenclever's three nodular sclerosing Hodgkin's lymphoma for which he received adjuvant chemotherapy. An incidental pT1a pN0 thyroid papillary microcarcinoma in the adjacent thyroid parenchyma was completely excised. This represents a case of TO Hodgkin's lymphoma, of which there are no current published case reports. We aim to raise awareness about this rare condition by sharing the diagnostic work up and successful management in a multidisciplinary team setting.


Assuntos
Carcinoma Papilar/diagnóstico , Neoplasias Esofágicas/diagnóstico , Doença de Hodgkin/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Sons Respiratórios , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Traqueia/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia com Agulha de Grande Calibre , Carcinoma Papilar/complicações , Carcinoma Papilar/patologia , Carcinoma Papilar/terapia , Quimioterapia Adjuvante , Diagnóstico Diferencial , Dispneia/etiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Esôfago/cirurgia , Doença de Hodgkin/complicações , Doença de Hodgkin/patologia , Doença de Hodgkin/terapia , Humanos , Achados Incidentais , Masculino , Esvaziamento Cervical , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/cirurgia , Resultado do Tratamento , Ultrassonografia
5.
Endocr Pract ; 27(1): 15-20, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33471728

RESUMO

OBJECTIVE: Some surgeons believe that dissection posterior to the right recurrent laryngeal nerve lymph node (PRRLN-LN) is unnecessary for the low metastasis rate and high complication risk. However, persistent metastatic lymph nodes may have a higher recurrence rate, surgical risk, and complications. Thus, it is important to distinguish patients who require PRRLN-LN dissection. To identify the risk factors for lymph nodes posterior to the right recurrent laryngeal nerve metastasis (LN-prRLN) and establish a scoring system to help determine whether PRRLN-LN dissection is required in patients with papillary thyroid carcinoma. METHODS: 821 participants were randomly allocated to the development and validation cohorts in a 2:1 ratio. A nomogram-based predictive model for LN-prRLN was established based on the risk factors identified in the development cohort. RESULTS: LN-prRLN was diagnosed pathologically in 124 of 821 patients (15.1%) from the entire cohort. Multivariate analysis identified age (odds ratio [OR], 0.964; 95% CI, 0.945-0.983; P < .001), tumor size (OR, 1.536; 95% CI, 1.135-2.079; P = .005), extrathyroidal extension (OR 2.271, 95% CI, 1.368-3.770; P = .002), clinically involved right central compartment lymph node metastasis (OR 1.643, 95% CI, 1.055-2.559; P = .028), and right lateral lymph node metastasis (OR 4.271, 95% CI, 2.325-7.844; P < .001) as the predictors of LN-prRLN. A risk model was established and well validated. Calibration curves to evaluate the nomogram in both the development and validation cohorts revealed a concordance index of 0.756 ± 0.058 and 0.745 ± 0.042, respectively. CONCLUSION: Our scoring system may be useful for helping the surgeons decide which patients should undergo the dissection of PRRLN-LN.


Assuntos
Carcinoma Papilar , Carcinoma , Neoplasias da Glândula Tireoide , Carcinoma/cirurgia , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/cirurgia , Humanos , Linfonodos , Esvaziamento Cervical , Recidiva Local de Neoplasia , Nervo Laríngeo Recorrente , Estudos Retrospectivos , Câncer Papilífero da Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
6.
BMC Surg ; 21(1): 53, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482804

RESUMO

BACKGROUND: To investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). METHODS: This study included PTC patients who underwent total thyroidectomy (TT) with at least central neck dissection and then re-operated due to recurrence of LNs between January 2013 and June 2018. These patients were grouped by negative or positive serum Tg levels according to the American Thyroid Association guidelines. RESULTS: Of the 60 included patients, 49 underwent radioactive iodine (RAI) treatment. Maximum unstimulated Tg (uTg) ≥ 0.2 ng/mL were associated with larger diameter of recurrent LNs (P = 0.027), and higher rate of metastatic LNs (P < 0.001). Serum-stimulated Tg (off-Tg) ≥ 1 ng/mL (P = 0.047) and unstimulated Tg (on-Tg) ≥ 0.2 ng/Ml (P = 0.013) were associated with larger diameter of recurrent LNs. Number of metastatic LNs ≥ 8 was an independent predictor for postoperative maximum uTg ≥ 0.2 ng/mL (OR = 8.767; 95% CI = 1.392-55.216; P = 0.021). Ratio of metastatic LNs ≥ 25% was an independent predictor for off-Tg ≥ 1 ng/mL (OR = 20.997; 95% CI = 1.649-267.384; P = 0.019). CONCLUSION: Postoperative Tg-positive status was associated with larger size of recurrent LNs. Number of metastatic LNs ≥ 8 and ratio of metastatic LNs ≥ 25% were independent predicators for uTg-positive and off-Tg-positive status, respectively.


Assuntos
Recidiva Local de Neoplasia , Tireoglobulina/sangue , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Adulto , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Câncer Papilífero da Tireoide/sangue , Câncer Papilífero da Tireoide/radioterapia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
7.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318270

RESUMO

Mucoepidermoid carcinomas (MECs) are the most common malignant tumour of the salivary glands. MECs have also been reported to occur in atypical sites. Primary MECs of the thyroid gland are extremely rare, accounting for 0.5% of thyroid malignancies with approximately 48 cases reported in the literature. In most cases, these are low-grade neoplasms with good long-term prognosis. We present the case of a 74-year-old patient with poorly differentiated MEC of the thyroid gland, which behaved aggressively resulting in rapid decline and death of the patient. The exact pathophysiology of the disease remains unclear and there is no consensus on the optimal treatment for this histological subtype. Recognition and diagnosis of this rare neoplasm are important as this can help guide optimal treatment, although in high-grade poorly differentiated cases, treatment options remain limited.


Assuntos
Carcinoma Mucoepidermoide/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Carcinoma Mucoepidermoide/secundário , Carcinoma Mucoepidermoide/cirurgia , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/secundário , Esvaziamento Cervical , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
8.
Gan To Kagaku Ryoho ; 47(10): 1481-1484, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130745

RESUMO

This case showed shoulder impairment due to paralysis of the trapezius and sternocleidomastoid muscles, swelling of the right hand, and dysphagia after undergoing endoscopic oropharyngeal cancer resection and cervical dissection for the posterior wall of the oropharynx. The rehabilitation and dysphagia treatment including electrical stimulation and repetitive facilitative exercises were performed for paralysis of the trapezius and sternocleidomastoid muscles. Consequently, improvements in paralysis of the trapezius and sternocleidomastoid muscles and swallowing function were obtained. The patient recovered from the functional decline caused by postoperative radiation therapy within 2 weeks and was discharged. The patient did not develop post-operative secondary sarcopenia despite being hospitalized for 152 days.


Assuntos
Neoplasias Orofaríngeas , Músculos Superficiais do Dorso , Estimulação Elétrica , Humanos , Esvaziamento Cervical , Músculos do Pescoço , Neoplasias Orofaríngeas/terapia
9.
Zhonghua Wai Ke Za Zhi ; 58(11): 870-875, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120451

RESUMO

Objective: To examine the feasibility of small drain in transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods: A prospective research was performed in Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, from October 2018 to March 2019. Totally 103 patients who met the inclusion and exclusion criteria, signed the operation agreement of TOETVA, had their surgery completed and followed-up over 6 months, were enrolled in analysis. A central venous catheter was used as a drain tube in all cases (outer diameter 1.7 mm, inner diameter 1.0 mm). Visual analogue scale (VAS) was applied for assessing pain scores during the first 24 hours after the operation. Vancouver scar scale (VSS) was used for assessing the scar left by the drainage. The drainage volume (minimum scale:10 ml, approximate read: 1 ml) was recorded every 2 hours during the first postoperative 12 hours, every 4 hours during 12 to 24 hours, every 8 hours during 24 to 48 hours, and once from 48 hours until extubation. The volume of drainage, the cumulative volume and the percentage of cumulative volume accounting for the total volume were calculated. The data of residual volume (subtract the cumulative volume from the total volume) in the postoperative 24, 32 and 40 hours were analyzed, and their upper one-side P(95) was calculated by percentile method. Results: There were 12 males and 91 females. The age was (36.6±9.7) years (range: 18 to 58 years). The intraoperative tube-inserting time was (10.1±2.6) minutes (range: 6 to 18 minutes). The pain score on the first day was 2.7±1.1 (range: 1 to 5). The extubation time was (2.7±0.5) days (range: 2 to 4 days). VSS scores in the postoperative 1(st) month and 6(th) month were 2.9±1.3 (range: 0 to 7) and 0(2)(M(Q(R))), respectively. The size of the scar was 0 (2.5) mm in the postoperative 6(th) month. Sixty-four patients had no visible scars. There were 5 patients who had postoperative drain-related complications (1 for air leakage, 1 for tube blockage, 3 for subcutaneous hydrop, 2 for regional infection), who were all cured after proper treatment. The total volume of drainage for 98 patients without postoperative drain-related complications was (80.1±12.2) ml (range: 58 to 131 ml). The cumulative drainage within 8 hours accounted for (53.8±4.2)% (range: 41.0% to 62.9%) of the total drainage. The volume of residual fluids in the postoperative 32 hours was estimated to (5.8±2.7) ml (range: 0 to 12 ml,P(95)=10.0 ml). Conclusions: The small drain tubecan be applied in TOETVA, providing a satisfied cosmetic appearance and a reliable drainage. The main exudation period of the wound is within 8 hours after the operation. If a residual volume less than 10 ml is considered to be self-absorbable, the shortest safe extubation point for 95% patients without drain-related complications should be 32 hours after the operation.


Assuntos
Drenagem/instrumentação , Endoscopia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural , Esvaziamento Cervical , Estudos Prospectivos , Tireoidectomia/métodos , Adulto Jovem
10.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 34(9): 836-839;843, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33040510

RESUMO

Objective:A prospective randomized controlled study of patients with thyroid papillary carcinoma requiring lateral neck dissection was conducted to investigate the thoroughness, safety and cosmetic features of endoscope-assisted lateral neck dissection. Method:Patients who underwent total thyroidectomy, bilateral central lymph node dissection and unilateral lateral neck dissection for papillary thyroid cancer were randomly divided into two groups: endoscopic assisted group and open group, 18 cases in each group. The clinical characteristics, operation conditions, postoperative complications and aesthetic satisfaction of the two groups were compared. Result:There were no statistically significant differences between the endoscopic group and the open group in age, gender, tumor size, dissection side, operation time, postoperative hospital stay, number of lymph nodes to be dissected, number of metastatic lymph nodes, postoperative hoarseness, and hypoparathyroidism(P>0.05); No hematoma or lymphatic leakage occurred in the two groups after surgery, and no tumor recurrence or residual was found in the ultrasound review at 6 months after surgery. Serum Tg level in the endoscopic group was higher than that in the open group at 6 months after surgery, but the difference between the two groups was not statistically significant(P>0.05); The neck pain score at day 3 after operation, the neck numbness and discomfort score at month 1 after operation, and the aesthetic satisfaction score at 3 months after operation in the endoscope assisted group were better than that in the open group(P<0.05). Conclusion:Endoscope-assisted lateral neck dissection is safe, feasible and with excellent cosmetic effect for the treatment of lymph node metastasis in the lateral cervical region of papillary thyroid carcinoma.


Assuntos
Carcinoma Papilar , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Humanos , Recém-Nascido , Linfonodos , Metástase Linfática , Esvaziamento Cervical , Estudos Prospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
11.
Cochrane Database Syst Rev ; 10: CD010787, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33085088

RESUMO

BACKGROUND: Bilateral neck exploration (BNE) is the traditional approach to sporadic primary hyperparathyroidism. With the availability of the preoperative imaging techniques and intraoperative parathyroid hormone assays, minimally invasive parathyroidectomy (MIP) is fast becoming the favoured surgical approach. OBJECTIVES: To assess the effects of minimally invasive parathyroidectomy (MIP) guided by preoperative imaging and intraoperative parathyroid hormone monitoring versus bilateral neck exploration (BNE) for the surgical management of primary hyperparathyroidism. SEARCH METHODS: We searched CENTRAL, MEDLINE, WHO ICTRP and ClinicalTrials.gov. The date of the last search of all databases was 21 October 2019. There were no language restrictions applied. SELECTION CRITERIA: We included randomised controlled trials comparing MIP to BNE for the treatment of sporadic primary hyperparathyroidism in persons undergoing surgery for the first time. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts for relevance. Two review authors independently screened for inclusion, extracted data and carried out risk of bias assessment. The content expert senior author resolved conflicts. We assessed studies for overall certainty of the evidence using the GRADE instrument. We conducted meta-analyses using a random-effects model and performed statistical analyses according to the guidelines in the latest version of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: We identified five eligible studies, all conducted in European university hospitals. They included 266 adults, 136 participants were randomised to MIP and 130 participants to BNE. Data were available for all participants post-surgery up to one year, with the exception of missing data for two participants in the MIP group and for one participant in the BNE group at one year. Nine participants in the MIP group and 11 participants in the BNE group had missing data at five years. No study had a low risk of bias in all risk of bias domains. The risk ratio (RR) for success rate (eucalcaemia) at six months in the MIP group compared to the BNE group was 0.98 (95% confidence interval (CI) 0.94 to 1.03; P = 0.43; 5 studies, 266 participants; very low-certainty evidence). A total of 132/136 (97.1%) participants in the MIP group compared with 129/130 (99.2%) participants in the BNE group were judged as operative success. At five years, the RR was 0.94 (95% CI 0.83 to 1.08; P = 0.38; 1 study, 77 participants; very low-certainty evidence). A total of 34/38 (89.5%) participants in the MIP group compared with 37/39 (94.9%) participants in the BNE group were judged as operative success. The RR for the total incidence of perioperative adverse events was 0.50, in favour of MIP (95% CI 0.33 to 0.76; P = 0.001; 5 studies, 236 participants; low-certainty evidence). Perioperative adverse events occurred in 23/136 (16.9%) participants in the MIP group compared with 44/130 (33.9%) participants in the BNE group. The 95% prediction interval ranged between 0.25 and 0.99. These adverse events included symptomatic hypocalcaemia, vocal cord palsy, bleeding, fever and infection. Fifteen of 104 (14.4%) participants experienced symptomatic hypocalcaemia in the MIP group compared with 26/98 (26.5%) participants in the BNE group. The RR for this event comparing MIP with BNE at two days was 0.54 (95% CI 0.32 to 0.92; P = 0.02; 4 studies, 202 participants). Statistical significance was lost in sensitivity analyses, with a 95% prediction interval ranging between 0.17 and 1.74. Five out of 133 (3.8%) participants in the MIP group experienced vocal cord paralysis compared with 2/128 (1.6%) participants in the BNE group. The RR for this event was 1.87 (95% CI 0.47 to 7.51; P = 0.38; 5 studies, 261 participants). The 95% prediction interval ranged between 0.20 and 17.87. The effect on all-cause mortality was not explicitly reported and could not be adequately assessed (very low-certainty evidence). There was no clear difference for health-related quality of life between the treatment groups in two studies, but studies did not report numerical data (very low-certainty evidence). There was a possible treatment benefit for MIP compared to BNE in terms of cosmetic satisfaction (very low-certainty evidence). The mean difference (MD) for duration of surgery comparing BNE with MIP was in favour of the MIP group (-18 minutes, 95% CI -31 to -6; P = 0.004; 3 studies, 171 participants; very low-certainty evidence). The 95% prediction interval ranged between -162 minutes and 126 minutes. The studies did not report length of hospital stay. Four studies reported intraoperative conversion rate from MIP to open procedure information. Out of 115 included participants, there were 24 incidences of conversion, amounting to a conversion rate of 20.8%. AUTHORS' CONCLUSIONS: The success rates of MIP and BNE at six months were comparable. There were similar results at five years, but these were only based on one study. The incidence of perioperative symptomatic hypocalcaemia was lower in the MIP compared to the BNE group, whereas the incidence of vocal cord paralysis tended to be higher. Our systematic review did not provide clear evidence for the superiority of MIP over BNE. However, it was limited by low-certainty to very low-certainty evidence.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Monitorização Intraoperatória/métodos , Hormônio Paratireóideo/sangue , Paratireoidectomia/métodos , Adulto , Viés , Humanos , Hiperparatireoidismo Primário/sangue , Hipocalcemia/epidemiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pescoço/cirurgia , Esvaziamento Cervical/métodos , Duração da Cirurgia , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Paralisia das Pregas Vocais/epidemiologia
12.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(5): 484-488, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-33085229

RESUMO

How to improve the effects of treatment on patients with oral squamous cell carcinoma (OSCC) has always been the focus of clinical and basic studies. The standardized diagnosis and treatment of malignant tumors aim to improve the effects of treatment, and individualized treatment based on standardized diagnosis and treatment may further improve these effects. On the basis of the existing guidelines for the diagnosis and treatment of patients with OSCC, this study explored the opportunities and challenges of standardized and individualized diagnosis and treatment of OSCC. These challenges and opportunities were related to the updates of clinical and pathological staging system, surgical margins, and neck dissection in patients with OSCC at early stage and preoperative induction therapy and postoperative adjuvant treatment in patients with advanced OSCC. This study also shared ideas on clinical studies of OSCC to optimize the existing treatment schemes, improve the treatment effects, and enhance the guidelines.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Carcinoma de Células Escamosas/patologia , Humanos , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Neoplasias Bucais/terapia , Esvaziamento Cervical , Estadiamento de Neoplasias
13.
Georgian Med News ; (304-305): 32-37, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32965246

RESUMO

The goal of research is to optimize the results of surgical treatment of the regional metastases of the maxillofacial area cancer by improving the technique of supragioid and supraomogioid neck dissection with its variants and substantiate the possibility of their application to the patients with malignant tumors of the maxillofacial area. 104 patients aged 7 to 86 years with malignant tumors of the maxillofacial area were examined, including cancer of the lower lip, oral mucosa, and salivary glands. The patients revealed 187 enlarged regional lymph nodes, which were removed in the course of surgery using advanced methods of supragioid and supraomogioid neck dissection. The proposed advanced neck dissection demonstrated high efficiency against regional metastases. In patients who have undergone surgery, the connection of the risk of regional recurrences with the presence of regional metastases has not been established.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Laríngeas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Esvaziamento Cervical , Recidiva Local de Neoplasia , Adulto Jovem
14.
BMC Surg ; 20(1): 173, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736545

RESUMO

BACKGROUND: Laryngeal rhabdomyosarcomas (RMSs) mainly occurred in children, while were extremely rare in adults. Consequently, less information was available to guide clinicians to manage adult RMSs in larynx. CASE PRESENTATION: A 42-year-old man presented with a 2-year history of gradually worsening hoarseness. Then, he underwent a surgery with suspension laryngoscope with initially being diagnosed as vocal cord cyst. Unexpectedly, the lesion was proved to be embryonal rhabdomyosarcoma (ERMS), pathologically. Next, he underwent chemoradiotherapy, while the tumor relapsed 18 months after the last treatment. Subsequently, a vertical hemilaryngectomy and a right selective neck dissection was performed, and the chemotherapy according to the anticancer drug sensitivity in vitro was arranged. Until the last check-up 18 months after chemotherapy, the patient did not display clinical or radiological signs of local recurrence and metastases. CONCLUSIONS: Misdiagnosis and missed diagnosis of laryngeal RMSs might appear when tumors presented as smooth protuberance. We reported the first case of laryngeal RMSs in an adult with the multidisciplinary strategy based on the chemosensitivity assay in vitro. Furthermore, a systematic review of the literature was also discussed, highlighting the initial diagnostic pitfalls and subsequent management problems that may occur with this uncommon tumor.


Assuntos
Neoplasias Laríngeas , Laringe , Recidiva Local de Neoplasia/terapia , Rabdomiossarcoma Embrionário , Adulto , Quimiorradioterapia , Terapia Combinada , Erros de Diagnóstico , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/terapia , Laringectomia , Laringe/cirurgia , Masculino , Esvaziamento Cervical , Rabdomiossarcoma Embrionário/diagnóstico , Rabdomiossarcoma Embrionário/cirurgia , Rabdomiossarcoma Embrionário/terapia
15.
Int J Oral Maxillofac Surg ; 49(12): 1545-1547, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32771273

RESUMO

Head and neck surgery for advanced neck disease may require ablation of critical structures, including the internal jugular vein (IJV). Although unilateral ligation of the IJV is not commonly associated with a significant increase in morbidity, bilateral sacrifice of the internal venous system may cause severe complications. We present the case of a 60-year-old man with a T4N2cM0 tumour of the left and right hypopharynx. The evolution of the disease required a bilateral modified radical neck dissection and sacrifice of both IJVs. We describe a vein grafting technique for the IJV using the external jugular vein as a donor vessel. Postoperative computed tomography imaging confirmed adequate blood perfusion. This report describes two new and accessible surgical options for immediate IJV grafting. Although this modification slightly increases the surgery time and technical difficulty, it allows immediate restoration of venous perfusion, which may improve the prognosis and patient outcomes.


Assuntos
Neoplasias de Cabeça e Pescoço , Esvaziamento Cervical , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/cirurgia , Masculino , Pessoa de Meia-Idade , Pescoço , Tomografia Computadorizada por Raios X
16.
Rev Col Bras Cir ; 47: e20202545, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844910

RESUMO

INTRODUCTION: papillary thyroid carcinoma is a tumor with good prognosis. However, some patients treated present neck recurrence. OBJECTIVE: to evaluate the risk factors for neck recurrence. METHODS: a retrospective study enrolled 89 patients (68 women and 21 men) diagnosed with papillary carcinoma who underwent total thyroidectomy. In 21 patients, neck dissection was performed and 62 patients underwent radioiodinetherapy. Twelve patients relapsed with metastasis in this period with an average of 3.6 years. RESULTS: out of 89 patients, 76.4% were female. Relapse occurred in nine (13.23%) women and three (14.28%) men. The average age of the patients was 44 years in the control group and in patients with relapsed. Eighteen patients (23.37%) in the control group and eight (64.28%) who relapsed had positive lymph nodes at initial diagnosis. The tumor size was significantly larger in the group of patients with cervical recurrence (3.3cm vs. 1.6cm - p=0.008, Student t test), whereas the presence of metastatic lymph nodes at the moment of the first operation was also significant (p=0.004 -Fisher exact test). The tumor size was an independent risk factor for recurrence at the multivariate anaylsis (OR=2.4, IC95%:1.3-4.6 - p=0,007, logistic regression). CONCLUSION: there is an increase in the risk of lymph node recurrence during the follow up of 2.4 folds for each increase of 1cm in the longer nodule diameter.


Assuntos
Carcinoma Papilar/cirurgia , Esvaziamento Cervical , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
17.
Artigo em Chinês | MEDLINE | ID: mdl-32842233

RESUMO

Objective:To investigate the relationship between lymph node metastasis in rⅥb region and pathological features of papillary thyroid microcarcinoma, and the application value of carbon nanoparticles in the operation for lymph node dissection in rⅥb region. Method:One hundred and seventy-five patients were divided into carbon nanoparticles group and the control group depending on whether carbon nanoparticles were used in the operation. The operation time, the number of central lymph node, the number of rⅥb region lymph node, hypocalcaemia symptom complex and hoarseness after the operaion were compared between the two groups. The lymph node metastasis in the rⅥb region and the pathological features of papillary thyroid microcarcinoma were statistically analyzed. Result:The amount of lymph nodes in Central District and rⅥb region was increased and the probability of parathyroid gland injury was decreased by using nano-carbon. The positive rate of lymph nodes in rⅥb region was not related to age, sex, aspect ratio of nodules and microcalcification, but was related to the tumor size, multifoci and the invasion of the capsule. The evaluation model of lymph node metastasis in rⅥb region was established based on the above three correlative features of color doppler ultrasound. The ROC curve analysis showed that the model had high application value . Conclusion:The tumor size, multiple foci and capsule invasion are risk factors for lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma.


Assuntos
Carbono , Neoplasias da Glândula Tireoide/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Esvaziamento Cervical , Estudos Retrospectivos , Tireoidectomia
20.
PLoS One ; 15(8): e0237133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760097

RESUMO

BACKGROUND: Accessory nerve shoulder dysfunction is common after neck dissection in oral cancer survivors. This study aimed to investigate the short-term effects of scapular muscle strengthening exercises with motor-control techniques on neck dissection-related shoulder dysfunction in oral cancer survivors before the initiation of radiotherapy. METHODS: Thirty-eight participants were randomly allocated into the motor-control and regular-exercise groups. Each group received conventional physical therapy and specific scapular muscle strengthening exercises for 1 month immediately after neck dissection. Motor control techniques were integrated with scapular strengthening exercises for the motor-control group. Shoulder pain, active range of motion (AROM) of shoulder abduction, and scapular muscle activities including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) when performing maximal voluntary isometric contraction (MVIC) and scapular muscle exercises were evaluated at baseline and after 1 month of training. RESULTS: Both groups reduced shoulder pain and increased muscle activity of maximum voluntary isometric contraction (MVIC) of each muscle after the intervention. Increased AROM of shoulder abduction was only observed in the motor-control group (95% CI 3.80 to 20.51, p = 0.004). Relative to baseline evaluation, muscle activities of UT decreased in the motor-control group when performing shoulder shrug with 1-kg weight (95% CI -33.06 to -1.29, p = 0.034). Moreover, the SA activity decreased in the motor-control group (95% CI -29.73 to -27.68, p<0.001) but increased in the regular-exercise group (95% CI 28.16 to 30.05, p<0.001) when performing shoulder horizontal adduction and flexion. CONCLUSION: Early strengthening exercise with motor control techniques has greater benefits for improving AROM of shoulder abduction, muscle economy, and reducing compensatory scapular muscle activities in patients with neck dissection-related shoulder dysfunction before the initiation of radiotherapy.


Assuntos
Terapia por Exercício/métodos , Neoplasias Bucais/cirurgia , Força Muscular , Esvaziamento Cervical/efeitos adversos , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/radioterapia , Contração Muscular , Amplitude de Movimento Articular , Ombro/fisiopatologia , Músculos Superficiais do Dorso/fisiopatologia
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