With the advancement of thyroid tumor treatment concepts and the progress of standardized treatment processes nationwide, the 5-year survival rate of thyroid tumors in China has risen from 67.5% in 2003 to 84.3% in 2015. As China has been continuously enriching its treatment options for advanced thyroid cancer in recent years, gradually improving the standardized treatment system for early and intermediate thyroid cancer, enhancing multidisciplinary collaboration methods and concepts, and regularizing scientific statistics, the survival rate of thyroid tumors continues to improve. We still need to consider the future development direction and core driving force of China’s thyroid discipline, correctly view the “prosperous” stage of domestic thyroid discipline development, and actively review the future development direction of China’s thyroid discipline.
ObjectivesTo systematically review the safety of harmonic scalpel and conventional resection in superficial parotidectomy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) or cohort studies of harmonic scalpel and conventional resection in superficial parotidectomy from the inception of the database to December, 2018. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies involving 671 post-cesarean section patients (361 patients in harmonic scalpel group and 310 patients in conventional resection group) were included. The results of meta-analysis showed that: compared with conventional resection, harmonic scalpel had shorter operative time (MD=−23.82, 95%CI −31.20 to −16.44, P<0.000 01), less postoperative drain output (MD=−26.25, 95%CI −38.95 to −13.55, P<0.000 1), less intraoperative blood loss (MD=−23.78, 95%CI −28.64 to −18.91, P<0.000 01), shorter duration of hospital stay (MD=−1.19, 95%CI −2.14 to −0.23, P=0.02), and lower temporary facial nerve palsy rate (OR=0.27, 95%CI 0.14 to 0.50, P<0.000 1). However, there was no significant difference in the incidence of parotid gland leakage between two groups (OR=0.42, 95%CI 0.16 to 1.06, P=0.07).ConclusionsThe current evidence demonstrates that, compared to conventional resection, harmonic scalpel resection is safer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To investigate the feasibility and effect of human amniotic membrane in prevention of tendon adhension after tendon sheat defect repair. Methods The amniotic membrane in size of 1.5 cm × 1.0 cm was harvested from human placenta which was voluntary donated from maternal after cesarean. Forty healthy male Leghorn chicken (aged 3-6 months) were selected, weighing (1.86 ± 0.04) kg. The model of flexor digitorum profundus tendon and tendon sheath defects was established at the third toe. After repair of the flexor digitorum profundus tendon, the human amniotic membrane was used to repair the tendon sheath defect in the right foot (group A), but tendon sheath defect was not repaired in the left foot (group B) . At 1, 2, 4, and 6 weeks after operation, the gross and histological observations were done; the degree of tendon adhesions was graded according to Tang’s tendon adhesion general observation grading standards; and the biomechanical properties (tendon slip length and total flexion angle) were tested. Results All animals survived after operation and incisions healed. Gross and histological observations showed that the new tendon sheath formed with time passing after operation in groups A and B; new tendon sheath was more maturer and smoother in group A than in group B. The degree of tendon adhesions in group A was significantly less than that in group B (P lt; 0.05) at 1 and 6 weeks after operation. The biomechanical test results showed there was no significant difference in the tendon slip length between 2 groups at 1 and 2 weeks after operation (P gt; 0.05), but the tendon slip length of group A was significantly longer than that of group B at 4 and 6 weeks after operation (P lt; 0.05). The total flexion angle of group A was significantly smaller than that of group B at 1, 2, 4, and 6 weeks after operation (P lt; 0.05). Conclusion It is effective in the prevention of tendon adhesion to use the amniotic membrane for repairing the tendon sheath defect, which is beneficial to recovery of the tendon sliding function.
ObjectiveTo explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures.MethodsBetween January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases.ResultsAll fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up.ConclusionThe minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.