地方性甲状腺肿的外科手术治疗体会

目的对地方性甲状腺肿的外科手术治疗经验进行总结。方法选取2014年3月-2016年10月住院接受外科手术的地方性甲状腺肿患者62例,对其临床就诊资料进行分析探讨。结果 62例患者全部治愈,术后分别出现暂时性低钙抽搐、声音嘶哑以及喝水呛咳3种不良反应,其中,暂时性低钙抽搐2例,声音嘶哑2例,喝水呛咳3例,不良反应发生率为11.29%。结论在对轻度地方性甲状腺肿患者和中度地方性甲状腺肿患者进行手术治疗时,既不要放置引流物,也不要切断患者的舌骨的舌骨下肌群,这样才能提高手术治疗的效果,减少不良反应发生率。     

纵形劈开舌骨下肌群入路切除甲状腺良性结节

为探讨甲状腺良性结节切除术中良好的手术入路 ,减少术后并发症的发生 ,自 2 0 0 1年以来 ,我们对 2 0例甲状腺良性结节采用纵形劈开舌骨下肌群的入路方式进行手术切除 ,效果满意。现报告如下。临床资料 :本组 2 0例中 ,男 12例、女 8例 ,年龄 14～ 6 0岁、平均 30岁。其中甲状腺腺瘤 15例 ,结节性甲状腺肿 5例。病变直径 1～ 5 cm。手术方法 :常规颈部横切口 ,剥离或不剥离颈阔肌皮瓣(根据结节部位和大小 ) ,不缝扎颈前静脉主干。结节位于峡部者切开颈白线即可 ,结节位于腺叶者提拉开结节侧胸锁乳突肌 ,电刀纵形切开位于结节深面的舌骨下肌…     

14例小儿地方性甲状腺肿手术治疗观察

本文共收集8～12岁小儿地方性甲状腺肿手术治疗14例,分析了部分较严重的甲状腺肿病儿,尤其是腺肿较大,对呼吸有严重压迫者采取手术治疗的必要性,同时以手术前、后的处理及手术后可能发生的合并症加以分析。1 材料与方法 本组共手术治疗小儿地方性甲状腺肿14例,其中男5例,女9例,年龄最小者8岁,最大者14岁,平均年龄12岁。本组病例全部为结节性肿大,其中合并有甲状腺囊肿者6例,合并甲亢者1例。     

甲状旁腺全切除加前臂自体移植术的手术配合

继发性甲状旁腺亢进(SHPT)是慢性肾衰竭尿毒症期的常见并发症,近年来其发病率逐渐增高,严重影响了患者的生存率及生活质量.2012年2 ～ 10月,我院成功实施了11例甲状旁腺全切除并前臂自体移植手术,取得了满意效果.现将手术护理配合方法报告如下. 临床资料:本组11例均患慢性肾功能不全(尿毒症期),行维持性血液透析,术前查甲状旁腺素(PTH)升高,曾口服药物治疗效果不佳.经术前准备后行甲状旁腺全切除加前臂自体移植.手术方法:①甲状旁腺全切除:常规消毒铺巾,取胸骨上窝2横指处顺皮纹弧形切口,逐层切开.在颈阔肌与颈深筋膜浅层间游离皮瓣,无菌巾护皮后,向头、尾两侧牵开皮瓣;纵行切开颈白线,向后方拉开舌骨下肌群,充分暴露后方的甲状腺;将甲状腺向内前方牵拉,显露外侧甲状腺静脉并予以切断;将甲状腺往内侧翻转,在甲状腺背侧甲状腺床探及甲状旁腺.根据甲状旁腺解剖位置、颜色、形状、大小,切除高度可疑的甲状旁腺肿物;取部分甲状旁腺组织送冰冻病理,将余下甲状旁腺组织立即置于冰盐水中.待术中病理结果证实为甲状旁腺后,充分止血;生理盐水冲洗切口,放置橡皮引流片;用3-0可吸收线间断缝合颈阔肌,4-0无损伤缝线皮内缝合皮肤.     

巨大地方性甲状腺肿手术切除的体会

目的 总结巨大地方性甲状腺肿手术切除的经验。方法 对1980-2000年间手术治疗的19例巨大地方性甲状腺肿的临床资料进行回顾性分析。结果 均行双侧甲状腺大部或次全切除术，切除标本最大径平均为12.6cm(9-16cm)，无手术死亡病例。术后声音嘶哑、饮水呛咳、手足搐ruo各1例，分别于术后13，9，5d恢复正常，18例获访3-15年，均达到临床治愈。结论 恰当的切口，充分的术野显露，气管软化的正确判定，准确识别病理状态下的甲状腺血管和毗邻神经的走行变位，有效的控制和预防出血等，均是影响巨甲手术切除疗效的重要因素。     

甲状腺结节268例临床及病理分析

目的对268例因甲状腺结节住院手术治疗的患者资料进行回顾性分析。方法本组共研究268例于2003年8月至2008年8月在我院外科因甲状腺结节住院手术治疗且甲状腺功能正常的患者,对所有患者的临床、实验室检查及病理资料进行回顾性分析。结果268例中222例为结节性甲状腺肿（83.8%）,其中121例为单纯性结节性甲状腺肿,101例为结节性甲状腺肿伴出血、囊性变或腺瘤样增生。恶性肿瘤17例,其中甲状腺乳头状腺癌14例（5.2%）,甲状腺滤泡癌2例,甲状腺髓样癌1例。恶性肿瘤患者年龄多在30～49岁,均为查体发现。14例恶性肿瘤超声为低回声实性单结节,6例扫描冷结节。其余病例分别为甲状腺腺瘤、桥本氏病。结论本组甲状腺结节手术病例以良性疾病,尤其结节性甲状腺肿占多数。B超为低回声实性单发结节且扫描为冷结节者恶性可能性大。对无症状且甲状腺功能正常的甲状腺结节,应结合多种辅助检查综合判断结节性质,争取行甲状腺细针抽吸细胞学检查明确诊断,减少良性结节患者不必要的手术。     

颈白线入路与胸锁乳突肌前缘入路甲状腺手术方式的比较

甲状腺手术多采用切断颈前肌群,以达到术野的充分显露。1999年1月至2002年8月,我们采用经颈白线入路甲状腺手术180例,经胸锁乳突肌前缘入路甲状腺手术28例,并对两种入路方式进行了比较。现报告如下。 临床资料:颈白线组180例,男10例,女170例,年龄20～68岁,平均34岁。单侧单发甲状腺囊肿58例,单侧多发18例;单侧单发甲状腺腺瘤46例,单侧多发3例;峡部囊肿3例,腺瘤6例;双侧多发甲状腺囊肿19例,双侧多发腺瘤9例;结节性甲状腺肿18例。胸锁乳突肌前缘组28例,全部为女性;年龄32～50岁,平均年龄36岁。单侧单发甲状腺囊肿     

甲状腺疾病术前、术后的护理

正甲状腺疾病是普外科的一种常见病、多发病,包括地方性甲状腺肿、甲状腺良恶性肿瘤、甲状腺功能亢进等,手术治疗是本病主要的治疗方法,且有较好治疗效果。我院外科2011年1月-2014年12月共施行甲状腺手术53例,1例术后发生甲状腺危象,经抢救好转,其余52例术后均顺利痊愈出院。现将术前术后的护理体会总结如下。1术前护理1.1术前做好周密的护理计划,对可能发生的并发     

甲状腺肿复发的原因分析

我省是地方性甲状腺肿流行病区。探讨甲状腺肿术后复发的原因,找出其预防的办法是在甲状腺肿手术治疗中值得注意的问题。本文分析了我院近１０年来共收治的１６例复发性甲状腺肿,现报告如下。１　临床资料本组患者１６例中,男性２例,女性１４例。年龄最小者２０岁,最大者５５岁。复发前诊断结节性甲状腺肿１１例,甲状腺囊肿１例,甲状腺腺瘤１例,结节性甲状腺肿继发甲亢２例,原发甲亢１例。复发时间在１年之内者６例,２～５年者６例,６～１０年者２例,１１年以上者２例。本组除２例未施行２次手术外,其余１４例均行２次手术治疗…     

地方性甲状腺肿和桥本氏病鉴别诊断

临床工作中地方性甲状腺肿和桥本氏病的鉴别诊断仍为外科的难题之一,由于诊断的不甚明确同时也给治疗带来了不同程度的困难。特别是桥本氏病人多伴是在术中或手术后才获得正确的诊断,从而给病人带来了不必要手术或甲状腺术后功能低下的痛苦,应用三种方法来区别两病的诊断,借以达到正确诊断和治疗地方性甲状腺肿,提高手术成功率同时降低桥本氏病的手术率和甲状腺功能低下的发生。     

Chromatographically purified immunoglobulin G of endemic and sporadic goiter patients stimulates FRTL5 cell growth in a mitotic arrest assay.

A strain of differentiated rat thyroid cells (FRTL5) in continuous culture was used to study the presence of thyroid growth-promoting immunoglobulins (TGI) in the serum of patients with endemic and sporadic euthyroid goiters. To identify true in vitro cell proliferation a microscopic mitotic arrest assay was used. Immunoglobulins G (IgGs) were prepared with QAE-Sephadex A-50 or protein-A-Sepharose. A positive growth stimulation index was found in IgG preparations of 65 of 71 patients with endemic goiter and in 9 of 14 IgG preparations of patients with sporadic goiter. IgG preparations of 15 control subjects from an area where endemic goiter due to iodine deficiency does not occur and of 18 subjects without iodine deficiency and without thyroid enlargement living in the endemic area did not stimulate FRTL5 cell growth. FRTL5 cell growth stimulation with IgGs of these euthyroid goiter patients could only be detected when IgG was tested in combination with a small dose of TSH. Immunoprecipitation with polyclonal and monoclonal antihuman IgG was able to abolish the growth-promoting effects. In 32 blinded samples the Feulgen cytobiochemical assay, formerly used to detect TGI, was compared with the FRTL5 mitotic arrest assay. The two methods showed similar results. Our observations of chromatographically purified IgG promoting thyroid cell proliferation in vitro provide good evidence that IgG was responsible for thyroid cell growth in vitro and suggest that autoimmune growth mechanisms may be involved in the pathogenesis of both endemic and sporadic goiters.     

Thyroid peroxidase in endemic goiter tissue

Thyroid peroxidase (TPO) activity and TPO protein were analyzed in endemic goiter tissue under iodine deficiency and after iodine supplement. TPO was prepared from 9 endemic goiter tissues and 4 normal thyroid tissues by solubilizing enzyme with detergent. Four patients with endemic goiter received iodized oil injection 12 months before surgery. All patients had normal serum thyrotropin (TSH) and thyroid hormone levels before surgery. TPO activity was measured by iodinase assay and guaiacol assay. Endemic goiter TPO showed greater iodination activity than that of normal TPO (p less than 0.01). The guaiacol assay showed greater TPO activity in 6 of the 9 endemic goiter tissues than that of the normal tissue. Iodized oil treatment did not affect TPO activity or TPO proteins when compared with those in untreated endemic goiter tissues. TPO activity in endemic goiter tissue correlated with thyroid T4 5'-deiodinase activity and not with thyroid hormone content in thyroglobulin. Since thyroid T4 5'-deiodinase and TPO are under control of TSH, an increase in TPO activity in the presence of normal serum TSH may be explained by the increased sensitivity of endemic goiter tissue to TSH-one of the possible adaptation mechanisms of endemic goiter.     

闭合性胰腺损伤21例的诊治分析

目的 探讨闭合性胰腺损伤的诊断治疗方法.方法 对近5年来收治并行手术治疗的21例闭合性胰腺损伤的临床资料进行回顾性分析.结果 21例患者中3例为单纯胰腺损伤,18例为合并腹腔内其他脏器损伤.根据胰腺损伤分级标准,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级损伤的例数分别为4、7、5、3、2例,仅有9例患者术前通过CT获得诊断,11例术中探查确诊,1例第一次手术时漏诊.手术方式采用局部引流或清创缝合后引流8例,连同脾脏的胰体尾切除5例,保留脾脏的胰体尾切除3例,近侧断端封闭、远侧断端胰腺空肠吻合3例,十二指肠憩室化加局部引流1例,胰十二指肠切除1例.12例手术后完全治愈,5例术后并发胰瘘,2例形成假性囊肿,均经引流而治愈,死亡2例.结论 胰腺闭合性损伤术前误诊率高,应尽可能采用CT检查以明确诊断;术中需仔细探查,选择简单、有效的手术方式,保证引流通畅是治疗成功的关键.     

Effect of acute levodopa load on blood prolactin concentration in patients with thyroid diseases

In 14 thyrotoxic patients and 5 persons with endemic euthyroid goiter the blood plasma prolactin content was studied under the action of an acute oral load of levodopa in a dose of 0.5 g. It was found that the basal prolactin level was significantly higher in the blood of patients of both sexes with thyrotoxicosis and endemic euthyroid goiter than that in the control group (10 healthy humans). The blood plasma prolactin content markedly decreased in thyrotoxic patients under levodopa effect, regardless of the sex, whereas in patients with endemic euthyroid goiter the drug exhibited no considerable action on the prolactin level. A possible mechanism of hyperprolactinemia in the thyroid hyperfunction is discussed.     

Deficiency of superoxide dismutase in endemic goiter tissue

Superoxide dismutase (SOD) activity and its concentration were measured in thyroid tissues obtained from patients with Graves' disease, Hashimoto's thyroiditis, differentiated thyroid cancer, and endemic goiter (before and after iodine supplementation) as well as in normal thyroid tissue (paranodular tissue) from patients with follicular adenomas. SOD activity was measured by pyrogallol assay in ethanol-chloroform extracts of the thyroid homogenates. The SOD concentration in the thyroid extract was measured as immunoreactive SOD by electroimmunoassay. Endemic goiter tissues (n = 10) contained significantly lower SOD activity [mean, 1.9 +/- 1.9 (+/- SD) vs. 7.5 +/- 3.9 ng purified SOD/micrograms DNA; P less than 0.02] and concentration (mean, 0.2 +/- 0.1 vs. 0.8 +/- 0.5 ng SOD/microgram DNA; P less than 0.01) compared with those of normal tissues. No other pathological thyroid tissues had such consistently low SOD levels. Lactate dehydrogenase activity, a marker of cytosolic enzyme, was not lower in endemic goiter tissues than in normal tissues, suggesting that both tissues possessed functioning cells capable of producing cytosolic enzyme. Thyroid tissue from endemic goiter patients previously treated with iodized oil injection also had low SOD activity and concentration. Western blot analysis indicated that SOD protein in the endemic goiter tissue did not differ from that in normal thyroid tissue. We conclude that there is deficiency of cytosolic SOD in endemic goiter tissue. Since the deficiency of cytosolic SOD causes more prolonged exposure to oxygen free radicals, the decrease in SOD might contribute to the degenerative changes frequently found in these tissues.     

The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis.

Endemic non-toxic goiter (NTG) in Greece has been attributed primarily to iodine deficiency. Thirty years ago about 60% of the prepubertal boys and girls examined in endemic goiter regions presented with NTG and among them thyroid autoimmunity was rarely detected. Although iodine supplementation has corrected this deficiency during the past 30 years, new cases of NTG still appear. To evaluate the prevalence and type of NTG and the effect of iodine supplementation on them in Greece at present, we performed two cross-sectional clinical studies and a retrospective pathology one: (i) thyroid gland volume and urinary iodine excretion (UIE) were assessed in a representative sample of 1213 schoolchildren from previously endemic and non-endemic regions; (ii) serum thyroxine, tri-iodothyronine, TSH, thyroid autoantibodies (AAB) (anti-thyroid peroxidase and anti-thyroglobulin antibodies) and UIE (in 60 patients) were measured in 300 consecutive patients with NTG from Athens and Heraklion; and (iii) we compared the prevalence of autoimmunity among fine needle aspiration smears of benign thyroid pathologies performed by the same pathologist between 1985 and 1986 (975 cases) and between 1994 and 1995 (2702 cases). We found that 12. 5% of the schoolchildren examined in regions with a previous history of endemic goiter had NTG, whereas this percentage was only 1.7% in areas without such a history. In Athens (61.6%) and Heraklion (58. 5%) a substantial number of NTG patients were AAB positive and biochemically hypothyroid. UIE in Athens did not differ between patients with autoimmune goiter (ATG) and simple goiter. The prevalence of autoimmune stigmata in pathology smears has increased from 5.94% (years 1985-1986) to 13.91% (years 1994-1995) (P<0.05). We conclude that: (i) the persistence of endemic goiter in regional foci despite iodine deficiency correction suggests a possible role for a naturally occurring goitrogen; (ii) ATG is the predominant form of NTG in Greece nowadays; and (iii) the five-fold decrease in the prevalence of NTG during the past 30 years followed by the increase of ATG may support the relative character of the latter.     

完全胸腔镜下体外循环心脏瓣膜手术279例

目的 探讨经胸腔镜体外循环心脏瓣膜手术的疗效和安全性.方法 于2012年1月至2014年6月在广东省人民医院经胸腔镜体外循环施行心脏瓣膜手术279例.包括二尖瓣换瓣201例,二尖瓣整形78例.合并三尖瓣整形98例,三尖瓣换瓣3例,清除左心房血栓19例,合并先天性心脏病房间隔修补5例,卵圆孔封闭术3例.使用30°胸腔镜及配套手术器械,股动脉插供血管,股静脉和（或）上腔静脉插引流管行体外循环,胸腔内操作均在胸腔镜下进行,以30°胸腔镜显示屏为手术野.结果 本组279例患者手术成功276例,成功率98.9％,术中转为正中开胸2例,术后行正中开胸止血1例.体外循环时间（144.3±44.4）min,升主动脉阻断时间（92.4±30.7） min,术后呼吸机辅助时间11（2～88）h,术后住院时间（8.2±4.6）d,术后24 h胸腔闭式引流量100（20～800） mL.全部患者无死亡.38例发生并发症,发生率13.6％;包括术中转正中开胸2例,术后二次止血14例,右侧气胸2例,肺炎9例,泌尿系统感染2例,消化道出血1例,心脏骤停1例,术后低心排血量综合征3例,伤口感染1例,伤口愈合不良2例,出现股静脉穿刺处血栓1例.术后随访复查心脏B超,时间为2～25个月,57例出现轻度二尖瓣反流（反流面积＜4 cm2）,5例出现中度二尖瓣反流（4 cm2≤反流面积＜8 cm2）,其中1例伴有二尖瓣中度梗阻.结论 完全胸腔镜下二尖瓣换瓣或整形术及三尖瓣换瓣或整形术是安全可行的.     

Natural course of asymptomatic pancreatic pseudocyst: a prospective study.

AIM: To study the natural course of asymptomatic pseudocysts of the pancreas. METHODS: Thirty patients (age range 18-68 years, mean 44; 24 men) with asymptomatic pseudocysts of the pancreas were enrolled between December 2001 and December 2003, and were followed up every month. Those who developed symptoms due to pseudocyst (increasing pain or features of obstruction such as vomiting or jaundice) were subjected to an endoscopic or surgical drainage procedure. End point of the study was either spontaneous resolution of pseudocyst or drainage procedure. RESULTS: Eighteen (60%) of 30 patients had resolution of the pseudocyst over an average duration of 5 months. Maximum diameter of less than 7.5 cm and cyst volume less than 250 mL were significantly more frequent in patients with resolution of pseudocyst than in those without (14/18 vs 2/12 [p=0.001] and 15/18 vs 2/12 [p=0.0003], respectively). Presence of internal debris was associated with non-resolution (9/12 vs 2/18; p=0.001). CONCLUSION: Pseudocysts with less than 7.5 cm diameter, volume less than 250 mL, and absence of internal debris were associated with spontaneous resolution within an average duration of 5 months.     

Evaluation of goiter using ultrasound criteria: a survey in a middle schoolchildren population of a mountain area in Central Italy

Iodine deficiency is still an important health care problem in the world. In Italy, as in most European countries, it is responsible for the development of mild to moderate endemic goiter. In 1995 we conducted a goiter survey in the Gubbio township, an area of Umbria region in Italy, close to the Appenine mountain chain. This study demonstrated a high prevalence of goiter in the middle schoolchildren population, indicating the presence of moderate endemic goiter. Soon after, a goiter prevention campaign aimed at implementing the consumption of iodinated salt was started. In 2001, a second survey was conducted in the middle schoolchildren (age 11-14 yr old) of Gubbio and neighbour townships. Eight hundred thirteen subjects were studied. Data obtained in 240 age-matched children, studied in the same area in 1995, were used for comparison to monitor changes 5 yr after the beginning of iodine prophylaxis. Thyroid volume was measured by ultrasonography. Gland volume was expressed in ml. A large population living in a iodine-sufficient area, previously reported by others, was used as control. Urinary iodine excretion was measured randomly in 20% of the children. The overall prevalence of goiter decreased between 1995 and 2001 from 29 to 8%. Goiter odds ratio (OR), corrected for age, was 4.0 (95% CI 2.8-5.9) for 1995 compared to 2001 (p<0.000). Mean thyroid volume in the matched populations was 7.6+/-2.5 ml in 1995 and 5.7+/-2.1 ml in 2001. Median iodine urinary excretion increased from 72.6 to 93.5 mug/l, at the limit of statistical significance. Living in a rural area, no consumption of iodized salt and familiarity for goiter represented independent risk factors for goiter development. This study was the first conducted in Umbria region and confirmed that an implementation campaign for iodized salt consumption is a simple and useful instrument to prevent endemic goiter and related diseases. A new survey to evaluate goiter prevalence in the same area 10 yr after the beginning of iodine prophylaxis is already planned.     

地方性甲状腺肿甲状腺浸润细胞及滤泡上皮DR抗原表达免疫组化研究

用一组识别淋巴细胞亚群与ＨＬＡ－ＤＲ抗原的单克隆抗体及ＡＢＣ免疫组化技术，对５０例地方性甲状腺肿的甲状腺粗针穿刺标本进行原位研究。结果发现：地甲肿甲状腺浸润细胞以Ｔ细胞为主，地甲肿弥漫型与结节型相比，前者甲状腺浸润细胞总数，Ｉ＾＋２细胞百分比，Ｌｅｕ７＾＋细胞百分比及ＤＲ＾＋滤泡上皮均少于后者，但Ｍ＾＋５细胞百分比则高于后者；提示从弥漫型地甲肿到结节型地甲肿甲状腺原位自身免疫反应逐渐加剧，部分病例