ObjectiveTo investigate the risk factors for neck lymph node metastasis (LNM) in papillary thyroid microcarcinoma, analyze the diagnostic value of high resolution ultrasonography in lateral neck LNM, and evaluate the safety of lymph node dissection. MethodsThe clinical data of 284 patients with papillary thyroid microcarcinoma from Janaury 2004 to June 2010 in this hospital were analyzed retrospectively. ResultsNeck LNMs were found in 83 of 284 patients (29.2%), only central LNMs in 63 of 284 patients (22.2%), skip LNMs (only lateral LNMs) in 6 of 284 patients (2.1%), and both central and lateral LNMs in 14 of 284 patients (4.9%). Age lt;45 years, multifocality, tumor diameter ≥5 mm, and extrathyroidal invasion were the risk factors for LNM (Plt;0.05), and no risk factor for skip LNM was found. Patients underwent central and lateral lymph node dissection had longer postoperative hospital stay than those without dissection or with central lymph node dissection only (Plt;0.05). Both parathyroid gland and recurrent laryngeal nerve injuries were temporary postoperatively. There were no differences in injury rate among three methods (Pgt;0.05). The sensitivity, specificity, false negative rate, and false positive rate of high resolution ultrasonography for only lateral neck LNM were 95.0%, 75.0%, 5.0%, and 25.0%, repectively. The positive predictive value and negative predictive value were 90.5% and 85.7%, respectively. ConclusionsTotal thyroidectomy should be performed in patients with risk factors for LNM, and simultaneous central lymph node dissection is safe. High resolution ultrasonography is of great value in diagnosing skip LNM, and functional lymph node dissection also should be applied in patients who are highly suspected to have skip LNM.
ObjectiveTo investigate the effects of thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) statuses on central lymph node (CLN) metastasis in patients with differentiated thyroid cancer (DTC).MethodsA retrospective analysis was performed on 526 patients with DTC confirmed by pathology from nine participating institutions, who underwent the bilateral thyroidectomy plus bilateral CLN dissection. The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared, and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.ResultsAll of 526 patients with DTC were included in this study, 152 were males and 374 were females. The age was (44±11) years old. There were 63 cases of TgAb＋TPOAb＋, 60 cases of TgAb＋TPOAb－, 30 cases of TgAb－TPOAb＋, and 373 cases of TgAb－TPOAb－. It was found that there was a significant difference in the gender among the four different antibody statuses of patients, that was, women with abnormal antibodies were more common (P<0.001), not found that there were related to the tumor size, blood vessel invasion, nerve invasion, CLN metastasis, tumor multifocality, and bilateral tumor or not (P>0.050). In this study, there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis. The results of multivariate analysis found that the age and gender of the patients were the independent risk factors (P<0.001), but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis (P>0.050).ConclusionsStatuses of TGAb and TPOAb aren’t obviously associated with CLN metastasis in patients with DTC, which is inconsistent with other studies. It needs to be further researched after expanding existing sample size and determining new predictive factors.
ObjectiveTo master the morphological characteristics of the recurrent laryngeal nerve (RLN) and extra-laryngeal branching (ELB) in dogs, and to provide an anatomical basis for the establishment of an animal model of injury to the ELB in dogs as well as for functional studies. MethodsSix adult healthy Beagles were selected, completely dissected the thyroid gland, the full length of the cervical segment of the RLN and the ELB. Then, the location, size and morphology of the thyroid gland and the morphological features of the RLN and ELB were observed. The length of the RLN and its ELB were measured. The incidence and number of ELB and their relationship with trachea, esophagus and peripheral blood vessels were recorded. ResultsSix Beagles (12 sides) all had ELB. In 9 sides the main trunk of the RLN divided into internal and external branches on its way up into the larynx and converged before them entering the larynx. The total number of ELB was 48, and the number of branches on each side were ranging from 1 to 7. There were 38 ELB were located below the lowest level of the thyroid gland. ConclusionsThe Beagles included in this study all have ELB. The ELB were widely distributed in the cervical trachea and esophagus after branching from the internal branch of RLN. It is speculated that the ELB may be involved in the function of the cervical esophagus and trachea. In thyroid surgery, the tracheal branch and esophageal branch of the ELB should be preserved as much as possible.
【Abstract】ObjectiveTo discuss how to identify and protect the parathyroid glands (PTGs) and their blood supplies during thyroidectomy. MethodsProtective measure of PTGs and their blood supplies were observed during the operation by eyes, as well as the occurrence of hypoparathyroidism after operation. Patients with syndrome of hypocalcaemia were given calcium and vitamin D3 supplementation until the serum calcium became normal. ResultsThere was no PTG found in 13 cases (13/259), 242 superior PTGs were found which were almost consistently (91.32%) located in the back sides of the thyroid glands and on the level of inferior edge of the thyroid cartilage. The blood supplies of 61 superior PTGs were often (68.85%) from the upper branch of inferior thyroid artery (ITA). Total 426 inferior PTGs were found, and the locations of which were more variable. Approximately 49.77% were located in the inferior 1/3 part of the back sides of the thyroids， 24.88% were positioned immediately to the inferior thyroid, where the ITA branches inserted into the thyroid. The blood supplies of 128 inferior PTGs were also mostly (80.47%) from the inferior branches of ITA system. There was no permanent hypoparathyroidism occurred and hypocalcemia after operation was happened to 27 patients, in which one patient of reoperation was underwent unilateral thyroidectomy, 3 patients were underwent unilateral thyroidectomy and contralateral subtotal thyroidectomy, 4 patients were underwent total thyroidectomy, 7 patients were underwent total thyroidectomy plus bilateral central neck dissection, 11 patients were underwent total thyroidectomy plus unilateral neck dissection, and one patient was underwent total thyroidectomy plus bilateral neck dissection. ConclusionThe blood supplies of PTGs are associated with their locations. The PTGs can be exposed and protected by eyes during operation. To prevent postoperative hypoparathyroidism, the PTGs should be protected in situ through meticulous dissection without
Objective To establish a rat model of pancreas-duodenal transplantation for pancreas transplantation research. Methods A rat model of pancreas-duodenal transplantation was established by using dual cuff technique. The graft affiliated portal vein and abdominal aorta were anastomosed to recipient’s left renal vein and left renal artery by using dual cuff technique without clamping the systemic circulation in order to minimize hemodynamic instability. Simultaneously the graft duodenum was anastomosed to the host jejunum in an end-to-side fashion to reestablish drainage of pancreatic secretion. Fluid replacement, warm keeping and anticoagulation were maintained during perioperative period. Results The average donor operation time was (68.4±7.2) min and recipient operation time was (26.1±3.3) min. Moreover, it took (5.0±1.1) min for cuff preparation in vitro and (9.6±3.5) min for vessel reconstruction in vivo, respectively. Intestinal anastomosis took (7.2±2.3) min. The operation successful rate was about 91.7%. Conclusion This pancreas-duodenal transplantation model avoids systemic circulation clamping. It is simple and stable, with the value in pancreas transplantation research.
Objective To investigate the pathogenesis of acute lung injury in rats induced by intra-peritoneally injection of perforative peritonitis ascitic fluids（PPAF） and the role of L-arginine （L-Arg） in acute lung injury in this model. Methods Perforative peritonitis （PP） models were established in 60 rats and PPAF were collected. Forty-eight rats were randomly divided equally into NS group，PPAF group, and L-Arg group. Rats were randomly subjected to death at 7 h and 12 h. Peripheral blood WBC were counted，levels of NO and malondialdehyde （MDA） in serum were examined. Lung injury score and wet/dry ratio were evaluated， and level of myeloperoxidase （MPO） in lung tissues and lung cell apoptosis were tested. Results WBC count of peripheral blood, levels of NO and MDA in serum， level of MPO in lung tissue, lung injury score， wet/dry ratio， and lung cell apoptosis rate in PPAF group were significantly higher than that in NS group at each time point（P＜0.01）. Level of NO in serum in L-Arg group was higher than that in PPAF group （P＜0.01）， but lower level of MDA in serum， lower level of MPO in lung tissue and lung injury score，lower wet/dry ratio， and lung cell apoptosis rate were observed in L-Arg group（P＜0.05）. In PPAF group and L-Arg group， level of NO in serum， wet/dry ratio, and lung cell apoptosis rate were higher at 12 h than that at 7 h（P=0.000）. Serum NO level was in negative correlation with serum MDA level （r=-0.257，P=0.021）， MPO level in lung tissue（r=-0.444， P=0.011），and lung cell apoptosis（r=-0.351， P =0.010） in PPAF group and L-Arg group， but serum MDA level was in positive correlation with cell apoptosis（r=0.969， P＜0.001） in each group. Conclusions Acute lung injury rats model can be established by intra-peritoneally injection of PPAF. Enhanced oxidizing reaction and cell apoptosis take part in the occurrence of acute lung injury. L-Arg plays a protective role in acute lung injury.
ObjectiveTo introduce patients with long-term hypocalcemia and normal parathyroid hormone (PTH) values after total thyroidectomy, and to analyze the possible causes of this phenomenon. MethodsThe medical records of 1 010 consecutive patients with total thyroidectomy treated in the Center for Diagnosis and Treatment of Thyroid Disease, the First Affiliated Hospital of Kunming Medical University from January 2019 to December 2020 were collected. Seven patients with normal PTH and blood calcium before operation and at least 2 times of PTH with hypocalcemia detected more than 6 months after operation were followed-up to understand the symptoms of hypocalcemia, vitamin D level and calcium consumption. ResultsSeven patients with thyroid papillary carcinoma underwent total thyroidectomy without parathyroid autotransplantation, and there were 6 cases with mild deficiency or insufficient of vitamin D before operation. The follow-up time was 12–28 months, and the median follow-up time was 19 months. Seven patients developed hypocalcemia after continuous administration of calcium and calcitriol, and vitamin D levels remained mild deficiency or insufficient, PTH decreased by more than 50% in 6 patients one year after operation compared with that before operation. ConclusionsPatients with long-term normal PTH values and hypocalcemia after total thyroidectomy have obviously lower PTH levels than those before operation. The possible factors are parathyroid damage during operation and vitamin D deficiency. Such these patients should be more properly referred to as “parathyroid insufficiency”.