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.
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 summarize the research progress of sentinel lymph node biopsy (SLNB) in the surgery of thyroid carcinoma in recent years. MethodsLiteratures about the recent studies on categories of SLNB and the neck lymph node dissection conducted by SLNB in the surgery of thyroid carcinoma were reviewed following the results searched from PubMed and CNKI data base. ResultsSLNB has a high detection rate and it is of great significance to detect the occult metastatic lymph nodes and guide the neck lymph node dissection during operation. ConclusionThe SLNB, with its high accuracy rate on the detection of occult metastatic lymph nodes, guides neck lymph node dissection during operation in order that it can maximize the benefits of patients.