Objective To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. Methods From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, the apo-cranial part of spinal accessory nerve was preserved from the trapezius muscle (gt;3.0 cm in length) and anastomosed to C7 posterior root. Objective physical examinations and electromyography were conducted before and after operation.One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. Results One, 6 and 12 months after operation, the recovery rates of each part were as follows: 9.8%, 68.9% and 73.5% in upper part; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases (70%) exceeded 90°. The mean maximal abduction angle was more than 95°. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade Ⅱ in 7 cases and grade Ⅲ in 3 cases. Conclusion Transpositional anastomosis of the C7 posterior root to thespinal accessory nerve after radical neck dissection can well reconstruct the function of trapezius muscle. This approach provides a wide indication in comparison with the functional neck dissection without impairment of arm function afterthe cutting of C7.
ObjectiveTo systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC). MethodsDatabases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups. ConclusionsTT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.
ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN0 papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. ResultsA total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. ConclusionTT+PCND is safe and feasible for treating stage cN0 papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.
ObjectiveTo explore the safety, effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma (PTC) by video-assisted lateral neck dissection (VALND) or open lateral neck dissection (OLND).MethodsThe clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. The data of 94 cases in the VALND group (n=47) and the OLND group (n=47) were finally included in this study, and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.ResultsThere were no statistical differences of lateral metastatic lymph node numbers, operative time, postoperative drainage volume, drainage tube removal time and postoperative hospitalization days between the two groups (P>0.05). The lateral retrieved lymph node numbers, intraoperative blood loss, the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group (P<0.05). There was no significant difference of surgical complications between the two groups (P>0.05).ConclusionWithout sacrificing surgical safety and effectiveness, VALND has better cosmetic effect and less neck trauma than OLND, which is worthy of clinical application and promotion.
Objective To explore the effectiveness of detailed physiotherapy in perioperative rehabilitation of patients undergoing thyroid cancer surgery with lymph node dissection. Methods A total of 97 patients with thyroid malignancy who underwent surgical treatment in West China Hospital of Sichuan University between February and June 2021 were selected and randomly divided into the trial group (n=50) and the control group (n=47). The patients in the trial group received detailed physiotherapy, and the patients in the control group received routine perioperative rehabilitation. The degree of pain within the operation area and the degree of neck and shoulder discomfort associated with surgery within 4 weeks, and the scores of Neck Dissection Impairment Index 4 weeks after surgery were compared between the two groups. The pain score, which was non-normally distributed, was described by median (lower quartile, upper quartile) and compared by generalized estimation equation; the discomfort score and score of Neck Dissection Impairment Index, which were normally distributed, were described by mean ± standard deviation, and the former was compared by multivariate analysis of variance, and the latter was compared by Student’s t-test. Results In the 1st, 2nd, 3rd, and 4th week after surgery, the pain scores within the operation area were 2.2 (1.7, 3.3), 1.5 (1.0, 2.2), 1.5 (0.0, 2.3), and 0.0 (0.0, 1.2), respectively in the trial group, and 3.4 (2.7, 5.2), 2.6 (1.5, 3.5), 2.4 (1.1, 3.4), and 1.5 (1.1, 2.0), respectively in the control group; the surgery-related neck and shoulder discomfort scores were 8.72±4.14, 5.28±2.98, 5.89±2.78, and 3.57±1.83, respectively in the trial group, and 10.56±5.30, 7.54±4.51, 7.37±3.49, and 5.05±2.59, respectively in the control group. Within 4 weeks after operation, the surgical-area pain scores and surgery-related neck and shoulder discomfort scores in the trial group were lower than those in the control group, and the differences were statistically significant (Wald χ2=28.826, P<0.001; F=7.695, P=0.007). In the post-operative week 4, the Neck Dissection Impairment Index in the trial group was higher than that in the control group, and the difference was statistically significant (75.23±20.40 vs. 63.83±19.52; t=2.809, P=0.006). Conclusion For patients undergoing thyroid cancer surgery with lymph node dissection, detailed physiotherapy intervention is more effective than routine perioperative rehabilitation.
ObjectiveTo summarize the efficacy and safety of Jindan Fuyan Granule in the treatment of refractory chylous leakage after neck lymph node dissection for thyroid cancer. MethodThe clinical data of thyroid cancer patients with refractory chylous leakage after neck lymph node dissection treated with Jindan Fuyan granules in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital from January to December 2023, were retrospectively collected. ResultsAfter treatment with Jindan Fuyan Granules on the basis of conventional treatment, the drainage volume of 3 patients with thyroid cancer after radical neck lymph node dissection was significantly reduced, from 100 mL to 2 mL, 1 285 mL to 5 mL, and 960 mL to 5 mL, respectively. After 3 days of treatment, the tubes were removed successfully. After discharge from the hospital, 3 patients were followed up for 3, 3, 4 months, respectively, showing satisfactory wound healing without chylous leakage or other discomfort. ConclusionsCombined with low-fat diet, drainage and other non-surgical treatment methods, Jindan Fuyan Granule has obvious effect on treating refractory chylous fistula after thyroid cancer neck lymph node dissection, which can be used as a non-surgical treatment option. However, the efficacy needs to be further verified.