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Developing Ideas and New Instruments in Thyroid Surgery

ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.

Chyle Leakage after Radical Neck Dissection

颈淋巴结清扫术后乳糜漏是颈部外科手术后比较少见的并发症，国内、外文献［1-7］报道其发生率约为1%～3%，其原因很明确，即术中损伤胸导管或其分支。颈淋巴结清扫术后乳糜漏对生命有潜在威胁，且显著延长患者住院时间、增加医疗费用。尽管手术方法及手术器械不断改进，其发生率并没有明显降低，对于部分难治性乳糜漏目前还没有简单有效的办法。现就颈淋巴结清扫术后乳糜漏的预防及治疗方法介绍如下……

Advances of relationship between p53 gene family and thyroid cancer

ObjectiveTo investigate the relationship between p53 gene family and thyroid cancer.MethodThe related literatures in the database were reviewed and analyzed.ResultsThe p53 gene family included p53, p63, and p73. The p53 played an important role in the development of thyroid cancer, especially in the development of undifferentiated thyroid cancer. The different subtypes of p63 might have different roles in the thyroid cancer, so it couldn’t be generally said that the p63 was an oncogene or an anti-oncogene, and the function of its specific protein needed to be further studied. The biological role of p73 in the thyroid cells might be contradictory, depending on the interaction of many different factors, and the interaction between various p73 subtypes and members of the p53 molecular network was still unclear.ConclusionThere is still some controversy about role of p53 gene family in development of thyroid cancer.

参附注射液对二尖瓣置换术患者围术期心肌酶及血流动力学的影响

目的 探讨参附注射液对体外循环二尖瓣置换术（MVR）患者围手术期心肌酶及血流动力学的影响。方法 将40例行MVR的患者随机分为实验组（n=20）和对照组（n=20），实验组于麻醉诱导后手术开始前、术后12、36和60h经静脉滴注参附注射液（1ml/kg）和250ml生理盐水；对照组输入等量的生理盐水。于术前、术后2、8、24、48和72h取静脉血检测两组血浆肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）含量，并观察血流动力学指标变化及术中、术后血管活性药物的用量。结果术后2、8、24、48和72h对照组血浆CK和CK—MB值均高于实验组（Plt;0.05）。主动脉阻断前、心脏复跳后30min、手术结束时实验组平均动脉压（MAP）均高于对照组（Plt;0.05）。术中和术后住ICU期间实验组多巴胺和氨力农的用量均低于对照组（Plt;0.05）。结论 参附注射液能减轻心内直视手术患者的心肌损伤，对心功能有一定的保护作用。

左胸腔和右髂内动脉克氏针移位一例

目的 报道1 例骨折内固定器械克氏针在人体内的移位。 方法 2004 年3 月，患者曾因右锁骨骨折行开放锁骨复位手术，用2 根交叉克氏针内固定，术后3 个月右锁骨骨折愈合，克氏针未行手术移除。2005 年4月，患者感左胸痛入院，行胸部及盆部X 线、CT 及三维重建，示固定在右锁骨上的2 根克氏针发生了移位，1 根在左侧胸腔，另1 根移位至右骶髂关节前方（右髂内动脉内）。行左侧胸腔切开取针和右髂内动脉切开取针术后，结扎右髂内动脉。 结果 术后患者恢复良好，胸痛缓解，右下肢活动感觉无异常。术后7 d 康复出院。 结论 采用克氏针行锁骨骨折内固定应牢固固定，否则易出现移位，引起严重后果。

Pseudomonas Aeruginosa Injection in Treatment for Lymph Leakage after Neck Dissection in Thyroid Carcinoma

目的　探讨铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的方法及效果。方法　笔者所在医院2012年4月至2012年7月期间共治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏患者4例，均采用铜绿假单胞菌注射液治疗。将铜绿假单胞菌注射液（1mL或2mL）通过引流管逆行注射到创腔，夹闭引流管1h后再开放引流管。结果　4例患者注射前1d24h引流量分别为200、350、540及810mL，其中2例患者为乳糜漏，引流时间分别为7d和15d；另2例患者为单纯淋巴漏，引流时间分别为13d和14d。注射1d后，引流量分别减少至20、45、120及255mL，4d后4例患者均顺利拔除引流管。4例患者治疗后均有不同程度的发热，经物理降温后体温恢复；均有不同程度的局部疼痛感，3例患者疼痛能耐受，另1例疼痛剧烈患者予以美洛昔康口服后缓解。结论　铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏的疗效显著。

Use of Harmonic Scalpel and Bipolar Coagulation Forceps Versus Harmonic Scalpel and Conventional Clampand-Tie Technique in Open Thyroid Surgery —— A Randomized Controlled Trial

Objective　To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.Methods　One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.Results　There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.Conclusions　The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.

Chyle Fistula after Neck Radical Dissection Using Harmonic Scalpel

ObjectiveTo investigate the cause and treatment for chyle fistula after neck radical dissection using harmonic scalpel. MethodsFrom January 2005 to April 2009, 105 patients with thyroid carcinoma underwent thyroidectomy by harmonic scalpel (harmonic scalpel group) and 110 patients with thyroid carcinoma by conventional procedures (conventional group). Postoperative chyle fistula in all the cases was studied retrospectively. ResultsThe incidence of chyle fistula was 5.71% (6 of 105 patients) in the harmonic scalpel group and 0.91% (1 of 110 patients) in the conventional group. The difference was significant between two groups (Plt;0.05). ConclusionsHarmonic scalpel increases the risk of chyle fistula in neck radical dissection. The conventional procedures with exposing and preserving or ligating the thoracic duct can reduce the risk significantly.

无症状型甲状腺内异位甲状旁腺瘤1例报道

Real-Time Monitoring of Recurrent Laryngeal Nerve During Thyroid Reoperation

Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor. Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection, exposure and protection of the RLN during the surgical procedures.Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact, the rest 2 nerves were resected because of tumor involving. Conclusions NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery, especially reoperation.