ObjectiveTo discuss the clinical significance of intact parathyroid hormone (iPTH) detection of postoperative serum and surgical drainage in predicting parathyroid function. MethodsThe clinical data of 50 patients with thyroid cancer performed total thyroidectomy from January 2013 to July 2013 in the PLA General Hospital and the First Affiliated Hospital of PLA General Hospital were analyzed retrospectively.In this cohort, there were 49 pappillary carcinomas and 1 medullary carcinoma.All the patients received total thyroidectomy andⅥlymph nodes dissection, and 18 of these patients received neck lymph nodes dissection additionally.The negative pressure drainage was placed in the operated area, and the drained fluid and blood were tested for iPTH level on the first day and the third day postoperatively. ResultsThe preoperative iPTH levels were within the normal range for all the patients.The postoperative serum iPTH level was (12.85±10.50) ng/L (4.64-13.15 ng/L) and (17.45±11.33) ng/L (7.33-26.50 ng/L) on the first day and the third day, respectively, there was no significant difference of the postoperative serum iPTH levels between the first day and the third day (P=0.293).The postoperative surgical drainage iPTH level was (1 550.29±1 678.18) ng/L (5 000-112 ng/L) and (566.73±753.99) ng/L (2 065-2.81 ng/L) on the first day and the third day, respectively, there was no significant difference of surgical drainage iPTH between the first day and the third day too (P=0.060). ConclusionsBy detecting the postoperative surgical drainage iPTH level combined with serum iPTH level, it could better predict the function of parathyroid after total thyroidectomy, and correctly assess the prognosis of patients.
Objective To observe the anti-adhesion and repair effect of 3 composite patches which composed of polylactide-co-caprolactone (PLC), hyaluronic acid (HA), collagen, and polypropylene (PP) mesh repairing abdominal wall defectin rats under contaminated environment, and to investigate the characteristics of 3 composite patches and the feasibil ity of onestage repair. Methods Ninety-three adult male Wistar rats (weighing 150-250 g) were randomly divided into 3 groups (n=31): PP/PLC composite patches (group A), PP/HA/PLC composite patches (group B), and PP/collagen/PLC composite patches (group C). One rat was selected from each group to prepare the contaminated homogenate of the small intestine. The abdominal wall defect models (1 cm in diameter) were established in other rats, and the defects were repaired with 3 composite patches (1.5 cm in diameter) according to grouping method. At 30, 60, and 90 days postoperatively, the adhesions was observed, and the patch and adjacent tissue was harvested for histological observation. Results Six rats died at 10-70 days postoperatively (2 in group A, 3 in group B, and 1 in group C). No wound infection, intestinal obstruction, or hernia occurred in 3 groups. Adhesion was observed between abdominal viscera and the patch, especially intestine, epiploon, and l iver. According to the modified Katada criteria, no significant difference in the adhesion score was found among 3 groups at 30 and 60 days (P gt; 0.05); the adhesion score was significantly lower in group C than in groups A and B at 90 days (P lt; 0.05). The histological results showed that inflammatory cell infiltration, fibroblasts, secreted collagen, and the residual absorbable material were observed around the patch at 30 days in 3groups. Decreased inflammatory cell infiltration, increased fibroblasts and residual PLC were observed at 60 days in 3 groups. At 90 days, the fibroblasts became increasingly mature, collagen deposited, the mesothelium formed gradually, and the residual PLC decreased. Conclusion In contaminated environment, PP/collagen/PLC composite patch is superior to PP/PLC and PP/HA/ PLC composite patches in aspect of abdominal adhesion and inflammatory reaction, and it is more applicable to one-stage repair of rat abdominal wall defect. But it is necessary to further study in the long-term efficacy and the security of the composite patch.
Objective To explore the reoperative techniques of differentiated thyroid carcinoma. Methods Clinical data of 56 patients who treated in The First Affiliated Hospital of General Hospital of PLA and General Hospital of PLA from Feb. 2011 to Feb. 2013 were analyzed retrospectively. Results All performed surgeries were successful. Surgeries took 90-150 minutes with an average of 120 minutes. Bleeding during surgeries was 70-200 mL with an average of 120 mL. Postoperative drainage was 90-210 mL with an average of 100 mL. The pathological diagnosis of the second surgery in 44 cases were as the same as the first， but there were no malignant tumor tissues of dissected glands in 12 cases. All patients had no postoperative bleeding and bucking， but 8 patients experienced hand and foot numbness， and 5 patientsexperienced transient hoarseness. Fifty patients were followed-up for 6-30 months （average 10.8 months） from the reoper-taion and 18-66 months （average 45.2 months） from the first operation， and rate of postoperative followed-up was 89.3%（50/56）. During the followed-up， 1 patient with papillary thyroid carcinoma and 1 patient with follicular thyroid carcinoma died in 44 months and 38 months respectively， 3 patients suffered lymph node metastasis at non-Ⅵ region ofaffected side， no one suffered recurrence. Conclusions For differentiated thyroid carcinoma patients who are undergoingthe second surgery， thorough whole body condition analysis should be performed and appropriate type of surgery should be chosen. By using recurrent laryngeal nerve monitoring， carbon nanoparticles for lymph node clearance， and protecting parathyroid gland to lower the possibility of postoperative complication， to improve survival rate and life quality.
ObjectiveTo compare postoperatively clinical effect of endoscopic total thyroidectomy via breast approach versus traditional total thyroidectomy via neck in treatment of thyroid papillary carcinoma on postoperative function of parathyroid gland. MethodsRetrospective study performed on 124 thyroid papillary carcinoma patients who were hospitalized between June 2014 and December 2015 in Department of General Surgery of The First Affiliated Hospital of General Hospital of PLA. All patients underwent total thyroidectomy plus central Ⅵ lymphadenectomy. Endoscopic total thyroidectomy via breast were applied on 48 patients and traditional total thyroidectomy via neck were applied on 76 patients. Serum intact parathyroid hormone (iPTH) and calcium on postoperative day 1 were monitored for all patients. Then comparison of the serum iPTH and calcium between the 2 groups was performed. ResultsSerum iPTH and calcium for all 124 patients were within the normal range before surgery, and there was no significant difference between the endoscopic total thyroidectomy via breast group and traditional total thyroidectomy via neck group in the serum iPTH and calcium (P > 0.05). On 1 day after surgery, the level of iPTH in endoscopic total thyroidectomy via breast group was lower than that of traditional total thyroidectomy via neck group[(20.8±5.7) pg/mL vs. (28.3±4.9) pg/mL], and ratio of lower iPTH than normal of endoscopic total thyroidectomy via breast group was higher[43.8% (21/48) vs. 22.4% (17/76)], P < 0.05; but there was no significant difference in serum calcium between 2 groups[(2.1±0.3) mmol/L vs. (2.0±0.5) mmol/L], P > 0.05. In addition, the incidence of perioral, chiral and pedal numbness was higher in endoscopic total thyroidectomy via breast group than that of traditional total thyroidectomy via neck group[47.9% (23/48) vs. 27.6% (21/76)], P < 0.05. ConclusionsComparably, endoscopic total thyroidectomy via breast approach is more prone to lowly postoperative serum iPTH and calcium. Patients are more prone to exhibit clinical symptom such as perioral numbness, chiral and pedal numbness.
To summarize the therapeutic method and effectiveness of parastomal hernia repair in situ with sublay methods. Methods Between February 2003 and May 2009, 34 patients with parastoma hernia were treated with Sublay methods using primary midl ine incision approach and polypropylene patch. There were 23 males and 11 females withan average age of 58.4 years (range, 43-78 years). The disease duration was 1 to 17 years (mean, 4.7 years). Of 34 patients, 6 had recurrent parastoma hernia. The diameter of hernia ring was 5-12 cm (mean, 7.2 cm). Results Sublay technique repair was successfully performed in all patients. The operative time was 96-160 minutes (mean, 116 minutes). The gastric tube was pulled out 12 hours to 5 days (mean, 3 days) after operation. The drainage tube was taken out at 2-7 days (mean, 4 days) after operation. The postoperative hospital ization time was 7 to 15 days (mean, 9 days). And the incisions of 32 patients healed by first intention. Incisional fat l iquefaction occurred in 1 case and infection in 1 case, and their incisions healed after dressing change. Seroma at the upper of the patch occurred in 7 patients and was cured by 2 to 3 times of percutaneous puncture and local pressure. Thirty-two patients were followed up 6-75 months (mean, 32 months). No chronic pain, lumping sensation, or local expansion in wound area occurred. Two recurrences occurred 3 months and 7 months after operation, respectively, and patients restored after expectant treatment or re-operation. Conclusion The in situ Sublay methods using primary midl ine incision approach and nonabsorbable patch is a feasible and safe method for parastomal hernia repair.
Objective To investigate the effectiveness of endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch for chronic abdominal wall sinus by comparing with the traditional surgical method. Methods Retrospective analysis was made on the clinical data of 53 cases of chronic abdominal wall sinus between January 2006 and May 2012. Of 53 patients, 18 underwent endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch (trial group), and 35 underwent traditional surgical treatment (control group). No significant difference was found in gender, age, etiology, disease duration, and location between 2 groups (P gt; 0.05). Results The blood loss during sinus clearance, postoperative hospitalization days, and sinus union time of the trial group were significantly better than those of the control group (P lt; 0.05), but no significant difference was found in the operative time for sinus clearance (t=0.28, P=0.78). No postoperative sinus bleeding or infection occurred in the trial group, but bleeding and infection in 5 and 3 cases of the control group respectively, showing significant differences between 2 groups (P lt; 0.05). The follow-up time was 4-18 months (mean, 12.4 months) in the trial group, and was 6-48 months (mean, 38.5 months) in the control group. No sinus recurrence was observed during follow-up. Conclusion Endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch has the following advantages in treating chronic abdominal wall sinus: clear view, thorough cleaning of granulation necrosis tissues, less bleeding, faster sinus union, and shorter hospitalization days; however, further observations on the long-term effectiveness and the safety are required .
Objective To explore the value of laparoscopy combined with gastroscopy in treatment for gastric stromal tumors. Method The clinical data of 45 patients with gastric stromal tumors performed laparoscopy combined with gastroscopy resection from June 2008 to June 2012 in this hospital were analyzed retrospectively. Results Forty-five patients with gastric stromal tumors were successfully excised by laparoscopy combined with gastroscopy， and the tumors were completely resected and no residual tumor at the edge. The length of surgical incision was about 4-6 cm with an average of 5.1 cm. The mean operation time was 75 min. Postoperative recovery was smooth， no surgery-related comp-lications occurred. The mean hospital stay was 6.8 d. No recurrence or metastasis happened within the follow-up with an average of 16.5 months. The immunohistochemical examination results：43 cases of CD117 was positive， 32 cases of CD34 was positive， 28 cases of SMA was positive， 2 cases of Desmin was positive， 22 cases of S-100 was positive. Conclusions The treatment of gastric stromal tumors through laparoscopy combined with gastroscopy is safe and effective. The benefits include minimal invasiveness， shorter operation time， and rapid postoperative recovery. The laparoscopy combined with gastroscopy can make more precise resection range， and avoid residual tumor and resection of excessive normal gastric tissue.
Objective To compare the therapeutic efficacy between the mini-incision anterior cervical approach thyroidectomy and modified Miccoli endoscopy assisted thyroidectomy for thyroid benign tumor. Methods Clinical data of 80 patients with thyroid benign tumor treated in The First Affiliated Hospital of General Hospital of PLA from Jan.2010 to Jan. 2012 were retrospectively analyzed，and the 80 patients were divided into mini-incision anterior cervical approach thyroidectomy group （n=40） and modified Miccoli endoscopy assisted thyroidectomy group （n=40） according to operative type. The operative time，drainage volume of neck，cosmetic satisfaction score，duration of hospitalization，expense of hospitalization，and rates of postoperative complication of 2 groups were compared and analyzed. Results The operative time of mini-incision anterior cervical approach thyroidectomy group were significantly longer than that ofmodified Miccoli endoscopy assisted thyroidectomy group〔（95.5±20.3）min vs. （62.4±15.5）min，P＜0.05〕，but thecosmetic satisfaction score〔（3.5±0.2） score vs. （4.3±0.1） score〕and expense of hospitalization〔（5 814.6±1 262.3）yuan vs. （9 846.7±1 080.5） yuan〕were lower （P＜0.05）. There were no significant differences on the drainage volumeof neck after operation〔（28.6±5.5） mL vs. （22.2±4.5） mL〕and duration of hospitalization〔（4.5±1.5） d vs. （3.8±0.9） d〕between the 2 groups （P＞0.05）. There were 3 cases happened transient hoarseness in mini-incision anterior cervical approach thyroidectomy group （all recovered in 1 month after operation） and 1 case in modified Miccoli endoscopy assi-sted thyroidectomy group （recovered in 3 months after operation），and there were no significant difference on incidence of recurrent laryngeal nerve injury （P=0.608）. No other complications happened. Conclusions Modified Miccoli endoscopy assisted thyroidectomy has better cosmetic benefit than mini-incision anterior cervical approach thyroidectomy， but more expensive. The patients who have specific cosmetic demand or engage in special profession can choose modified Miccoli endoscopy assisted thyroidectomy.
ObjectiveTo assess whether using three new types of domestic absorbable anti-adhesive coatings could prevent adhesion to prosthetic meshes. MethodsA rat model of 1 cm-diameter defect in the muscular abdominal wall was made, and a 1.5 cm-diameter mesh was fixed intraperitoneally to cover the defect. One hundred and twenty Wistar rats were randomly divided into four groups: polypropylene (PP)+polylactide-co-caprolactone (PLC) mesh group, PP+hyaluronic acid (HA)/PLC mesh group, PP+collagen/PLC mesh group, and PP+expanded polytetrafluoroethylene (ePTFE) mesh group. Five rats were executed on day 30, 60, 90, and 180 respectively after operation, adhesions were assessed according to Nair criteria and wound healing was studied by microscopy histologically. ResultsThe mean adhesion score of the PP+collagen/PLC mesh group was significantly lower than that of the PP+ePTFE mesh group on day 30, 60, 90, and 180 after operation (Plt;0.05). The mean adhesion score of the PP+PLC mesh group or PP+HA/PLC mesh group were the same as the PP+ePTFE mesh group at the same time (Pgt;0.05). No infections occurred, and occurrence of hernia was not found. ConclusionsMeshes with domestic absorbable coating can significantly reduce adhesion to mesh surface, especially with collagen and PLC coating. Meanwhile they are domestic, the costs are much lower, so the common people can afford to use. They have a good clinical prospect.