舌异位甲状腺的诊断与治疗

目的 :探讨舌异位甲状腺诊治方法。方法 :将我院从 1992年 10月～ 2 0 0 0年 2月收治的 18例舌异位甲状腺患者的临床资料进行总结分析 ,其中异位甲状腺全切除术 5例 ,部分切除术 3例 ,次全切除加部分带蒂移植10例。结果 :1例异位甲状腺癌行全切除术后出现甲状腺功能低下 ,部分切除术后 2例复发 ,其余 15例情况良好。结论 :术前常规B超检查、同位素扫描、细胞学检查和冰冻切片对异位甲状腺的诊断有指导意义 ;治疗上 ,患者无症状 ,异位甲状腺无恶变 ,可不予治疗 ,如果出现临床症状 ,对于副甲状腺 ,可作全切除术 ,若为迷走甲状腺 ,则行次全切除加部分带蒂移植是很好的方法     

无注气内镜下甲状腺次全切除术的手术护理

目的探讨无注气内镜下甲状腺次全切除术的手术方法及术中护理要点。方法6例经右侧锁骨上外侧1/3处行长2.5cm的小切口进入,分离皮下致颈阔肌后纵形切开颈白线,分离胸骨舌骨肌和胸骨甲状腺肌,暴露甲状腺,建立置镜通道,在内镜引导下用超声刀分别离断甲状腺下,上极血管,超声刀切割甲状腺,缝合创面,检查无活动性出血,放置引流管,皮内缝合手术切口,完成手术。结果刀口隐蔽完美,颈部无暴露的切口,手术术野清晰,出血减少,手术中副损伤减少。结论术前访视,术中积极的护理配合及观察对于无注气内镜下甲状腺手术的成功十分重要。     

1977例甲状腺手术临床分析

目的：总结甲状腺疾病手术治疗的临床经验。方法：收集近9年来经手术治疗的甲状腺病例的临床资料,统计经手术治疗的甲状腺疾病的分类,各类手术并发症的发生率。结果：9年来甲状腺手术共1977例。男女性别比为1：5．68,其中包括甲状腺肿789例,甲亢755例,甲状腺瘤353例,甲状腺癌19例,甲状腺炎4例,甲状腺再次手术57例。共出现各种手术并发症105例,发生率为5．31％,无手术死亡病例。结论;接受甲状腺手术治疗的患者以女性占多数,现阶段各种甲状腺疾病仍以手术治疗为主,手术治疗也是安全有效的。     

Abordajes en cirugía tiroidea

Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIX^th century, has become the “gold standard”. It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat.Endoscopic and robotic surgery have developed “new approaches” to thyroid in order to improve the cosmetic results, looking even for invisible scars.We have done a thoughtful review of most of them trying to understand their benefits and drawbacks.Currently none of these “new approaches” have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.     

The intracranial branch; A rare anatomical variation of the recurrent laryngeal nerve; Case report

IntroductionThe recurrent laryngeal nerve (RLN) originates from the Vagus nerve intrathoracically. It passes through the tracheoesophageal groove (TEG) in the neck and different variations in this section were observed. The RLN is at highest risk for injury during the thyroid surgery. Therefore, it is important to know variations to decrease the injury effectively.Presentation of caseA 50 years-old woman with no thyroid related complaints except for enlargement of the thyroid gland in recent 12-months that annoyed her during neck movement and for aesthetic features. Medical, surgical, drugs, irradiation history, laboratory data, and physical examination was unremarkable except for multi-lobulated enlarged thyroid gland. The CT scanning study revealed intrathoracic extension of the gland. Patient underwent total thyroidectomy with suspicious diagnosis of multinodular goiter which was confirmed later by pathologic study. Intraoperative exploration of the right RLN discovered an intracranial branch originating from the recurrent laryngeal trunk just beneath the inferior thyroid artery (ITA) at the level of the nerve intersection. The branch then passed laterally about 1 cm and penetrated in ipsilateral carotid sheath.DiscussionThe RLN has different anatomical variations in either the right or the left side of the neck. However extra-laryngeal nerve branching is the most common variation but other seldom variations including the non-RLN, and intracranial branch should be mentioned by surgeon intraoperatively.ConclusionTo decrease iatrogenic injuries to RLN and its associated nerve branches knowledge of the nerve anatomy is mandatory for surgeon to prevent morbid side effects.     

甲状腺切除病例喉返神经损伤的分析

目的：研究甲状腺切除术的主要并发症－－喉返神经（ＲＬＮ）麻痹的相关因素。方法：回顾性研究１５６３例甲状腺手术患者的临床资料,重点分析ＲＬＮ损伤与术式、ＲＬＮ在术中是否被分离保护以及与甲状腺疾病的病理关系。结果：ＲＬＮ损伤率是７．８％,与组织病理恶性程度明显相关（Ｐ〈０．０１）,但术中如明确找到ＲＬＮ并加以保护,术后则无ＲＬＮ永外性损害,暂时麻痹仅１．６％。结论：术中对ＲＬＮ的保护应该强调避免医源性     

甲状腺手术患者围术期预防应用抗菌药物的分析

目的了解我院甲状腺手术患者围手术期预防应用抗菌药物情况。方法对我院2011年117例甲状腺手术围手术期预防应用抗菌药物的种类、用药时间、更换品种等进行统计、分析。结果 117例手术患者有114例在围手术期预防性应用抗菌药物,占97.44%。药物种类以头孢类为主,占86.4%。预防用药时间平均为3.44d。不合理用药主要表现在预防用药档次高,首次用药时机不恰当,术后用药时间偏长、无指征换药等方面。结论需进一步加强临床医师的培训和管理,增强合理用药意识。     

分化型甲状腺癌的外科治疗

目的 总结分化型甲状腺癌的诊治经验.方法 回顾110例分化型甲状腺癌的临床资料.结果 全组均行手术治疗辅以内分泌治疗,110例分化型甲状腺癌中,病理示乳头状癌88例(80%),滤泡状腺癌22例(20%).淋巴结转移者22例(20%).手术方式包括单侧病变行患侧腺叶加峡部及对侧大部切除59例(其中功能性颈清扫12例),息侧腺叶加峡部切除29例(其中功能性颈清扫7例);双侧病变行一侧腺叶加峡部及对侧大部分切除18例(其中功能性颈清扫5例),甲状腺全切除术加双侧颈清扫2例;1例肺转移患者行甲状腺全切及颈部淋巴结清扫术后行[3]内放射治疗.98例术后随访10年生存率91.8%.结论 分化型甲状腺癌预后较佳,治疗关键是正确根据其病情选择合适的手术方式.     

低领小弧形切口在甲状腺切除术患者中的临床价值

目的研究低领小弧形切口在甲状腺切除术患者中的临床应用价值。方法选取2012年1月～2013年5月进行常规甲状腺切除术治疗的31例患者为对照组,并以31例采用低领小弧形切口手术进行治疗的患者为观察组,统计并比较两组患者的出血量、美观程度、并发症发生率及术后不同时间的疼痛程度。结果观察组的出血量小于对照组．美观程度优于对照组。并发症发生率低于对照组,术后疼痛评估结果均优于对照组,两组间差异有统计学意义（P〈0．05）。结论低领小弧形切口在甲状腺切除术患者中的综合应用价值较高,对患者的不良影响更小．美观程度也更受肯定。     

内镜下甲状腺切除术与常规甲状腺切除术比较的系统评价

目的评估内镜下甲状腺切除术与常规甲状腺切除术相比的有效性及安全性。方法检索国内外数据库中比较内镜下甲状腺切除术与常规甲状腺切除术的随机对照试验。完成数据提取和文献质量评价后,采用RevMan5.1软件对数据进行Meta分析。结果本评价纳入11个研究共1398例患者。内镜下甲状腺切除术的优点有美容评分高[SMD=4.23,95%CI(2.66,5.80),P<0.05]、伤口满意度高[RR=2.25,95%CI(1.89,2.70),P<0.05]。缺点是手术时间长[SMD=1.02,95%CI(0.44,1.59),P<0.05]、术后引流量多[SMD=0.89,95%CI(0.56,1.23),P<0.05]。两种手术方式的并发症、复发率均无差别。结论内镜下甲状腺切除术适用于对美容要求高的患者,同时需考虑其优缺点及费用。