Objective To investigate the anatomical character and variation of non-recurrent laryngeal nerve （NRLN）， and to explore measurement to identify and prevent injury of this nerve during thyroidectomy. Methods Clinical data of 2 211 patients who underwent thyroidectomy from Jan. 2007 to Jun. 2012 in Peking Union Medical College Hospital were analyzed retrospectively， and 114 patients with NRLN of related literature reviews were analyzed too. Results There were 3 479 recurrent laryngeal nerve （2 211 cases） which were exposed during thyroid operation in Peking Union Medical College Hospital， of which 11 cases were confirmed to be right NRLN （0.32%， 11/3 479）. Of the 11 cases， 3 cases were typeⅠ， 7 cases were typeⅡA， and 1 case was typeⅡB， one case was also found to have a recurrent branch. None of them injured during operation. One hundred and fourteen cases of NRLN （0.14%-4%） were found in literature reviews. Of the 114 cases， 109 cases were confirmed to be right NRLN， of which 4 cases were typeⅠ （3.7%， 4/109）， 75 cases were typeⅡA （68.8%， 75/109）， 9 cases were typeⅡB （8.3%， 9/109）， 21 cases were unclear （19.3%， 21/109）， 3 cases were also found to have a recurrent branch （2.8%，3/109）. Five cases were confirmed to be left NRLN， of which 2 cases were typeⅡA， 3 cases were unclear， 1 case was also found to have a recurrent branch. Of all the 104 cases reported by treatises and case reports， 16 cases injured during operation， of which 1 case was typeⅠ， 9 cases were typeⅡA， 6 cases were unclear. Conclusions NRLN， which is a rare anomaly， usually happens on the right， and very vulnerable during thyroid surgery. The most usually injured type is typeⅡA. Fully acknowledgment of the NRLN and its variant types is very helpful to avoid damage during thyroid surgery.
【Abstract】Objective To explore the operative technique of endoscopic thyroidectomy and prevent its complications. Methods A retrospective analysis was made on the clinical data of 32 patients with benign thyroid diseases who were treated with endoscopic thyroidectomy between May 2002 and March 2005. Results Thirtytwo cases were successfully treated with the mean operation time 130 min(80～180 min). Twelve cases with thyroid adenomas and 20 cases with thyroid tubers were confirmed by histologic examinations. In this group, the postoperative complications included fat liquefaction in 2 cases and transient hoarseness in 1 case who recovered 3 months after operation. No parathyroid injury occurred. The drainage tubes were removed 2~3 days after operation. All of the patients were discharged 2~5 days after operation.Conclusion Endoscopic thyroidectomy is safe and feasible with favorable cosmetic effect.
【Abstract】Objective To search for the significance of endoscopic thyroidectomy and parathyroidectomy. Methods Literatures about endoscopic thyroidectomy and parathyroidectomy were collected and reviewed. Results Thyroidectomy and parathyroidectomy may be performed with endoscope or with the help of endoscope. Conclusion By endoscopic thyroidectomy and parathyroidectomy, the patients are lightly injured without scar in the neck. The quality of life is improved.
OBJECTIVE In order to investigate the opportunity of repair and prognosis of recurrent laryngeal nerve injuries after thyroidectomy. METHODS Twelve cases with recurrent laryngeal nerve injuries after thyroidectomy were immediately and delayed operated on nerve repair and reinnervation. In immediate operation, 5 cases were repaired by direct recurrent laryngeal nerve suture, and 1 case was treated by transposition of the phrenic nerve to the recurrent laryngeal nerve and sutured the adductor branch to the branch of ansa cervicalis. In delayed operation, 3 cases were treated by anastomosis the main trunk of ansa cervicalis to the adductor branch of recurrent laryngeal nerve, and 3 cases were operated on neuromuscular pedicle to reinnervate posterior cricoarytenoid muscle. RESULTS Followed up 6 months, the effect was excellent in 1 case who was immediately operated by selective reinnervation of the abductor and adductor muscles of the larynx, better in 9 cases, and poor in 2 cases who were delayed operated over 12 months. CONCLUSION It can be concluded that the earlier reinnervation is performed, the better prognosis is.
Objective To explore the feasibility and safety of endoscopic thyroidectomy via chest-breast approachand summarize the operation skill. Method The clinical data of 40 cases performed endoscopic thyroidectomy via chest-breast approach from August 2010 to August 2012 in this hospital were analyzed retrospectively. Results The endoscopic thyroidectomies via chest-breast approach were successfully performed in all 40 patients without conversion to open surgery， massive haemorrhage， hypercapnia， severe subcutaneous emphysema， cutaneous necrosis on chest，permanent impairment of recurrent laryngeal nerve， and permanent hypoparathyroidism. One case of hoarseness was found on 2d after operation， who returned to normal after symptomatic treatment. One case of numbness in the extremitieshappened on day 2 after operation and the symptom was relieved through intravenous and oral administration of calcium treatment in 3d. One case of cutaneous tightness on chest happened， and it was spontaneous remission in a month. The operation time was （102±28.4） min （55-182 min）， intraoperative bleeding was （46±16.6） mL （30-106 mL）， and the drainage tube was removed postoperative 2-7d with an average （4±2.2） d， the postoperative hospitalization was 3-8 d with an average （4±1.1） d. All of the cases were followed-up after operation without low calcium， low parathyroid hormone， hoarseness， and local goiter recurrence. Two cases of hypoparathyroidism returned to normal after oral thyroxine dose adjustment. All the patients were satisfied with the cosmetic results. Conclusions The endoscopic thyroidectomy via chest-breast approach is safe and feasible with good cosmetic results. The subcutaneous Y tunnel， the “upper yellow middle white lower red” appearance on the chest， and the landmark of inverse trapezium on the neck are the key points for creation of operation compartment. Sufficient exposure， stepwise procedure， blunt dissection combined with sharp dissection in the precise gap are the surgical skills for endoscopic thyroidectomy.
Objective To compare the therapeutic efficacy between the mini-incision anterior cervical approach thyroidectomy and modified Miccoli endoscopy assisted thyroidectomy for thyroid benign tumor. Methods Clinical data of 80 patients with thyroid benign tumor treated in The First Affiliated Hospital of General Hospital of PLA from Jan.2010 to Jan. 2012 were retrospectively analyzed，and the 80 patients were divided into mini-incision anterior cervical approach thyroidectomy group （n=40） and modified Miccoli endoscopy assisted thyroidectomy group （n=40） according to operative type. The operative time，drainage volume of neck，cosmetic satisfaction score，duration of hospitalization，expense of hospitalization，and rates of postoperative complication of 2 groups were compared and analyzed. Results The operative time of mini-incision anterior cervical approach thyroidectomy group were significantly longer than that ofmodified Miccoli endoscopy assisted thyroidectomy group〔（95.5±20.3）min vs. （62.4±15.5）min，P＜0.05〕，but thecosmetic satisfaction score〔（3.5±0.2） score vs. （4.3±0.1） score〕and expense of hospitalization〔（5 814.6±1 262.3）yuan vs. （9 846.7±1 080.5） yuan〕were lower （P＜0.05）. There were no significant differences on the drainage volumeof neck after operation〔（28.6±5.5） mL vs. （22.2±4.5） mL〕and duration of hospitalization〔（4.5±1.5） d vs. （3.8±0.9） d〕between the 2 groups （P＞0.05）. There were 3 cases happened transient hoarseness in mini-incision anterior cervical approach thyroidectomy group （all recovered in 1 month after operation） and 1 case in modified Miccoli endoscopy assi-sted thyroidectomy group （recovered in 3 months after operation），and there were no significant difference on incidence of recurrent laryngeal nerve injury （P=0.608）. No other complications happened. Conclusions Modified Miccoli endoscopy assisted thyroidectomy has better cosmetic benefit than mini-incision anterior cervical approach thyroidectomy， but more expensive. The patients who have specific cosmetic demand or engage in special profession can choose modified Miccoli endoscopy assisted thyroidectomy.
Objective To investigate the indications and prevention of complications of total thyroidectomy in the management of thyroid diseases. Methods Eighty five patients who received total thyroidectomy between Jan. 2009 and Dec. 2011 were retrospectively analyzed with regard to the surgical procedures and postoperative complications. There were 46 thyroid cancers， 38 nodular goiters， and 1 Hashimoto thyroiditis. Results The postoperative pathological exam-inations revealed that 9 （19.6%） of 46 thyroid cancers were bilateral， and all of nodular goiters were also bilateral multiple nodule. Bilateral recurrent laryngeal nerves were exposed in all of the patients in which 4 recurrent laryngeal nerves were invaded by cancer and 1 was sacrificed. There were 5 patients whose parathyroids were not identified and protected during the operation. Two patients developed postoperative bleeding and needed reoperation， 6 patients developed hoarseness of whom 5 patients recovered except for the one whose nerve was sacrificed. And in terms of hypoparathyroidism， 33 （38.8%） patients developed transient hypocalcemia related symptoms. The permanent hypoparathyroidism occurred only in 2 patients. Conclusions Total thyroidectomy is a safe procedure in the management of thyroid cancer and bilateral nodular goiter. Exposing the recurrent laryngeal nerve and parathyroid is an effective method to prevent major complica-tions. Invasion of recurrent laryngeal nerve by thyroid cancer might not lead to hoarseness.
Objective To explore the clinical significance of exposure the recurrent laryngeal nerve（RLN） for preventing the RLN injury in thyroidectomy. Methods The data of 1 723 patients with thyroid diseases undergoing total or subtotal thyroidectomy from September 2006 to August 2011 were retrospectively reviewed. RLN were exposed in 914 cases, 1 203 RLNs were exposed（exposed group）. RLN were unexposed in 809 cases, 1 013 sides were cut（unexposed group）. To compare RLN injury rate after operation and recovery of vocal cord in 6 months after operation between the two groups. Results In exposed group, 11 cases had RLN injury, the rate of RLN lesion was 0.91%. In unexposed group, 21 cases had RLN injury, the rate of RLN lesion was 2.07%. The differences between the two groups had statistical significance（P＜0.05）. When six months after operation, 0 case and 13 cases in exposed group and unexposed group respectively occurred permanent RLN injury, the differences between the two groups had statistical significance（P＜0.01）. Conclusion Exposure of RLN in total and subtotal thyroidectomy can significant avoid RLN injury, especially RLN permanent injury.
Objective To evaluate if performing thyroidectomy through small incision has any notable aesthetic impact on patients compared with larger incision. Methods Thirty consecutive patients underwent thyroidectomy were enrolled from March 2008 to June 2008 in this prospective randomized pilot study. The incision length was 6 cm in the small incision group and 9 cm in the larger incision group. After 3 years follow-up，the scar aesthetics were evaluated by patients and surgeons using the Patient and Observer Scar Assessment Scale （POSAS），Vancouver Scar Scale （VSS），respectively. Digital photographs about scars were taken and assessed by non-research related viewers. Results There were 13 cases who received scar aesthetic assessment in both groups. The demographic characteristics of both groups were comparative. The overall patients’ satisfactions for the small incision group and the larger incision group were （2.5±1.9） scores and （2.2±1.5）scores， respectively （P=0.55）. There were no significant differences in scar assessment scale score as for other scar assessment scales （including VSS score，PSAS score，and OSAS score） between the two groups. The evaluation of digital photographs about scars by non-research related viewers was no significant difference （P＞0.05）. Conclusion Larger cervical scar in thyroidectomy does not decrease patients’ satisfaction with their scar results.
Objective To investigate the threshold value for postoperative parathyroid hormone （PTH） that can predict the development of symptomatic hypocalcemia. Methods The patients received total thyroidectomy and all the operations performed by the same team from June 2010 to December 2011 in the thyroid and breast group of department of general surgery，Xuanwu Hospital of Capital Medical University were enrolled in this prospective study. Serum PTH and calcium were tested at 1-hour postoperatively and thereafter every day during hospitalization. Symptoms of hypocalcemia were recorded. Receiver operator characteristic curve was plotted to test the value of PTH assay to predict symptomatic hypocalcemia. Results There were 45 consecutive patients recruited in this prospective study，9 （20.0%） patients remained normocalcemic and 36 （80.0%） patients developed hypocalcemia postoperatively. There were 19 （42.2%） patients who developed symptoms associated with hypocalcemia and needed calcium supplement. The postoperative PTHs for normocalcemic （n=9），asymptomatic （n=17），and symptomatic （n=19） hypocalcemia patients groups were （40.5±23.7） ng/L，（18.3±9.1） ng/L，and （7.6±4.2） ng/L，respectively （P＜0.001）. The PTH value less than 13.4 ng/L could easily predict who were at high risk to develop symptomatic hypocalcemia with sensitivity of 94.7% and specificity of 76.9%. Conclusions This study suggests that a 1-hour postoperative PTH level at 13.4 ng/L can identify those individuals at risk for developing symptomatic hypocalcemia. Therefore，we recommend early calcium supplementation for these patients to decrease their postoperative morbidity from symptomatic hypocalcemia.