表浅型食管癌经内镜黏膜下剥离术导致非治愈性切除的危险因素及长期生存分析

Objective To identify risk factors of non-curative resection in superficial esophageal cancer (SEC) after endoscopic submucosal dissection and to evaluate the prognosis. Methods We retrospectively analyzed the data of 207 SEC patients who received ESD. The median follow-up was 48 months. Results The en bloc resection rate was 89.25% (191/214), the complete resection rate was 80.84 % (173/214), the curative resection rate was 70.09% (150/214) and the non-curative resection rate was 29.91% (64/214). The maximum long diameter of specimen was 110 mm. Age, gender, tumor size, lesions performance during surgery and operation time were associated with the non-curative resection (P<0.05). Female, lesion diameter≥50mm and poorly performed lesions were identified as significant risk factors for non-curative resection. In the noncurative resection group, there was no difference in cancer-free survival and survival between patients who had no additional treatmeat after ESD and those who underwent surgery or radiotherapy. Conclusion For patients with poor general condition who are not willing to undergo surgery or chemoradiotherapy, regular endoscopy seems to be an option. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

Impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy

ObjectivesTo determine the impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy.Material and methodsA single-center retrospective study was conducted for a 5-year period in a university hospital center, including 605 patients undergoing total thyroidectomy, 52 of whom had mediastinal-recurrent cellular and lymph-node dissection.EndpointsThe main endpoint was intraoperative number of parathyroid glands as predictor of parathyroid hormone (PTH) level and postoperative hypocalcemia. The secondary endpoint was the correlation between associated mediastinal-recurrent cellular and lymph-node dissection and incidental parathyroidectomy and its impact on PTH level and calcemia in the immediate postoperative period and at 1 month.Results161 patients (26.61%) showed hypocalcemia in the immediate postoperative period and 12 (1.98%) at 1 month. Mediastinal-recurrent cellular and lymph-node dissection increased incidental parathyroidectomy risk 4.6-fold. Mediastinal-recurrent cellular and lymph-node dissection was associated with a statistically “suggestive” decrease in day-1 calcemia (P = 0.03), and no significant decrease at 1 month (P = 0.52). Incidental parathyroidectomy (6.7% of cases with parathyroidectomy versus 1.3% without) did not significantly increase the rate of early hypocalcemia (P = 0.28), but was associated with a “suggestive” worsening at 1 month (P = 0.02).ConclusionHypocalcemia after total thyroidectomy is a complex, probably multifactorial issue. Systematic parathyroid gland identification is not recommended due to the increased risk of gland lesion, mainly by devascularization. Incidental parathyroidectomy may induce hypocalcemia at 1 month postoperatively (statistically “suggestive” association).     

内镜辅助经下颌下入路腮腺深叶多形性腺瘤切除术

摘要：目的探讨内镜辅助经下颌下入路切除腮腺深叶多形性腺瘤的可行性及疗效。方法采用内镜辅助经下颌下入路切除腮腺深叶多形性腺瘤7例，其中男2例，女5例，年龄36～65岁，平均年龄47岁。主要症状是吞咽异物感5例，咀嚼不适感2例；主要体征为发现患侧咽侧壁、软腭部膨隆6例，另1例无明显阳性体征。结果本组7例手术均在1.5～2.5 h内顺利完成，肿瘤获得完全切除，切口甲级愈合。且无腮腺区肿胀、声嘶、呛咳、呼吸及吞咽困难、伸舌偏斜发生，其中1例术后2 d出现患侧口角歪斜，约1个月后完全恢复。术后病理均为多形性腺瘤。随访时间6～38个月，平均为20个月。结论内镜辅助经下颌下入路可以完全、彻底切除腮腺深叶多形性腺瘤，既能保留面神经功能，又有助于同时保护颈部重要血管、神经，值得临床推广应用。