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.
ObjectiveTo investigate the effectiveness of repair procedure using biological mesh with Onlay-Reinforce technique in patients with perineal hernia. MethodsBetween January 2005 and December 2012, 9 patients with perineal hernia after laparoscopic abdominoperineal resection for rectal cancer (Miles operation) were treated. There were 3males and 6 females with a mean age of 70 years (range, 61-78 years). The disease duration was 1-9 months (mean, 4.5 months). The most beginning symptom was distending pain in perineal region, and then reducible mass was found without bowel incarceration. All patients underwent hernia repair using biological mesh with Onlay-Reinforce technique through original perineal incision. ResultsThe hernial size was 9.8-20.5 cm2 (mean, 16.0 cm2); the size of biological mesh was 58-80 cm2 (mean, 70.2 cm2); and the intraoperative blood loss was 10-80 mL (mean, 50.5 mL). All of the patients underwent repair operation successfully. The operation time was 45-90 minutes (mean, 60.6 minutes); and the hospitalization time was 4-7 days (mean, 5.9 days). One patient had urine retention, which was relieved after 7 days indwelling catheter. All the wounds healed by first intention without infection. The patients were followed up 14.5-60.7 months (mean, 37.8months). No chronic pain, obvious foreign body sensation, or hernia recurrence developed. ConclusionUse of biological mesh with Onlay-Reinforce technique for the repair of perineal hernia after Miles operation is safe and effective.
ObjectiveTo study the causes and treatment of postoperative deviation secondary to thumb duplication resection. MethodsBetween February 2007 and June 2013,32 cases (33 thumbs) of postoperative deviation secondary to thumb duplication resection were treated,and the clinical data were retrospectively analyzed.There were 13 males and 19 females,aged 2-34 years (median,8 years).The left thumbs were involved in 7 cases,the right thumbs in 24 cases,and bilateral thumbs in 1 case.Of 33 thumbs,2 were rated as type Ⅱ,4 as type Ⅲ,10 as type IV,7 as type V,and 10 as type VⅡ according to Wassel classification.The average time between duplicated thumb resection and admission was 6.5 years (range,1-29 years).Nine thumbs only had ulnar deviation of the metacarpophalangeal (MP) joint;8 thumbs only had radial deviation of the interphalangeal (IP) joint;10 thumbs only had ulnar deviation of the IP joint;and 6 thumbs had ulnar deviation of the MP joint combined with radial deviation of the IP joint.The mean deviation degree of the MP joint was 32.3°(range,20-40°),and the mean deviation degree of the IP joint was 42.5°(range,30-110°).Operation methods were chosen specially according to the deformity,including remnant bone or cartilage resection,restoring normal alignment,and soft tissue balance. ResultsAll wounds got first stage healing and there was no complication associated with operation.Postoperative follow-up period ranged from 6 to 70 months (mean,34 months).The skeleton alignment of the thumbs was improved on the X-ray images;all osteotomy got union at 5-10 weeks (mean,6 weeks).Deviation was completely corrected in 31 thumbs;the preoperative deviation degree was too large to correct completely in 2 thumbs with a postoperative deviation degree of 10°.The motion degree was similar to that at preoperation in 13 thumbs;the motion degree decreased in 20 thumbs,which did not affect the function of the thumbs.Nineteen cases (20 thumbs) were followed more than 2 years,there was no recurrence of deviation and all thumbs developed well,but the size of affected thumb was smaller than that of the contralateral side in 14 cases (14 thumbs). ConclusionGetting good result and preventing postoperative deviation for thumb duplication resection acquires appropriate preoperative design,reconstruction of the insertion of the abductor pollicis brevis,transposition of the flexor and extensor pollicis longus insertion,and essential osteotomy play important roles in preventing postoperative deviation after thumb duplication resection.Individualized treatment plan for deviation should be made according to the degree and the cause of deviation.
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.
ObjectiveTo investigate the cl inical characteristics, diagnosis, and treatment of metacarpophalangeal (MCP) joint locking with extension lag. MethodsBetween February 2009 and April 2014, 17 patients (17 fingers) with MCP joint locking with extension lag were treated. The patients included 4 males and 13 females, and the average age was 40.7 years (range, 20-72 years). The index finger was locked in 12 cases and the middle finger in 5 cases. All patients could not fully extend the MCP joint at about 30° flexion without flexion limitation of the interphalangeal joint. The range of motion (ROM) of the MCP joint was (41.2±5.1)°. The visual analogue scale (VAS) score was 2.7±0.5. X-ray and CT scanning showed that there was a bony prominence on radial condyle of the metacarpal head in 15 primary patients, and a hook like osteophyte on ulnar condyle in 2 degenerative patients. All patients were treated with close reduction first, and open reduction was conducted when the manipulation failed. ResultsSuccessful close reduction was achieved in 5 cases, and successful open reduction in 8 cases; 4 cases gave up treatment after failure for close reduction. All patients who achieved successful reduction were followed up 2.3 years on average (range, 6 months to 5 years and 2 months). The ROM of the MCP joint was increased to (80.4±6.6)° at last follow-up, showing significant difference when compared with ROM before reduction (t=-19.46, P=0.00). The VAS score decreased to 0.2±0.4 at last follow-up, also showing significant difference when compared with score before reduction (t=13.44, P=0.00). ConclusionAccessory collateral ligament caught at the bony prominence on the radial condyle of the metacarpal head is the most common cause of the MCP joint locking with extension lag. Close reduction is feasible, but recurrence of locking is possible. Surgical treatment is advised in the event of manipulation failure or recurrent locking.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.
ObjectiveTo evaluate the results of corticoplasty for multiple enchondromatosis of the hand. MethodsBetween February 2003 and January 2011, 6 patients with multiple enchondromatosis were treated. Of 6 cases, 1 was boy and 5 were girls with an average age of 10.8 years (range, 9-12 years); 5 cases presented with painless mass as first symptom, and 1 case was found to have mass by X-ray film because of hand injury. Physical examination at admission showed multiple mass on the hands, fingers deformity, and limited range of motion; X-ray film results showed large lesions in the phalanges and metacarpals. Corticoplasty and simple curettage without bone grafting were performed on 24 fingers (60 bones) with multiple enchondromatosis of the hand. The fingers active range of motion was used to evaluate the finger function; the diameter of the tumors was measured on the X-ray films; and according to Tordai's classification, tumor recurrence and new bone formation were observed. ResultsOnce, twice, or three-time operations were performed in 2 cases, respectively. All patients were followed up 17-83 months with an average of 52.2 months. At last follow-up, the active range of motion was significantly increased from (230.8±53.2)° at preoperation to (255.0±28.7)° at postoperation (t=—3.829, P=0.001); the tumor diameter was significantly decreased from (15.6±5.8) mm at preoperation to (10.7±3.7) mm at postoperation (t=8.304, P=0.000). Of 60 bones, 34 (56.7%) were rated as Tordai grade 1, and 26 (43.3%) as Tordai grade 2. During follow-up, clinical manifestation, characteristics of radiology and pathological examination showed no pathological fracture or malignant change. ConclusionCorticoplasty is a safe and effective treatment for multiple enchondromatosis of the hand in children. The procedure can improve appearance and motion function of the hand.