氯诺昔康在鼻腔填塞术后镇痛效果的观察

目的：探讨氯诺昔康在鼻腔填塞术后的镇痛效果。方法：选取2011-01—2011-08行鼻腔填塞术患者56例,随机分为两组：①治疗组,术后常规给予氯诺昔康8mg（2m1）静脉注射,一日两次;②对照组,术后给予生理盐水2ml静脉注射,一日两次,其他治疗均同治疗组。应用视觉模拟量表分别于术后3、6、12、24及48h对患者术后鼻部头部胀痛程度及术后24、48h睡眠质量进行评分。结果：治疗组鼻腔填塞术后鼻部头部胀痛程度、夜间睡眠状态均明显优于对照组。结论：氯诺昔康在鼻腔填塞术后的短期使用镇痛效果明显,无明显不良反应。     

鼻内镜术后氯诺昔康镇痛与出血相关性的临床观察

目的 观察鼻内镜手术后应用氯诺昔康镇痛与患者抽除术腔填塞纱条时鼻腔出血情况的相关性.方法 接受鼻内镜手术治疗的238例鼻鼻窦疾病患者,随机分为观察组和对照组,术后均予以常规处理,但观察组患者术后加用氯诺昔康镇痛,对照组术后不用镇痛药物.观察比较两组患者抽除术腔填塞纱条时鼻腔出血量和出血发生率的差异.结果 观察组患者抽除填塞纱条时出血量及其率明显低于对照组,差异有统计学意义（P＜0.05）.结论 鼻内镜术后应用氯诺昔康镇痛,可以明显降低术后抽除鼻腔填塞纱条时的鼻出血的量和发生率。     

舒芬太尼与氯诺昔康用于改良悬雍垂腭咽成形术后镇痛

目的 观察舒芬太尼(sufentanil)和氯诺昔康(Iornoxicam)用于改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)后患者静脉自控镇痛(patients-controlled intravenous analgesia,PCIA)的有效性和安全性.方法 H-UPPP后行PCIA患者60例,随机分3组:舒芬太尼组(S组)、舒芬太尼复合氯诺昔康组(SL组)、氯诺昔康组(L组).观察各组患者PCIA 2、6、12、24、48小时后的镇痛效果.结果 S、SL组患者PCIA期间镇痛、镇静良好.在PCIA后2～24小时,L组镇痛评分、镇静评分、血压、心率与S、SL组比较差异显著(P<0.05):S组PCIA后2～12小时脉搏血氧饱和度较SL、L组低(P<0.05):SL组及L组镇痛并发症低于S组(P<0.05).结论 舒芬太尼与氯诺昔康联合应用于H-UPPP后PCIA效果确切,并发症少.     

甲状腺癌的术后随访及监控

分化型甲状腺癌是一个相对惰性病程的恶性肿瘤,也是全身预后较好及可治愈的恶性肿瘤之一。尽管初始治疗采用了全甲状腺切除和／或颈淋巴结清扫、放射性碘治疗及左旋甲状腺素（L-thyroxine,L-T4）抑制治疗等,患者仍有数年后发生复发和转移的可能,而且L-T4治疗需要长期应用。因此,对分化型甲状腺癌的术后随访和监控是非常必要的。     

女性甲状腺癌患者术后促甲状腺激素抑制治疗及其对经期的影响

女性甲状腺癌发病率高,术后需常规口服左甲状腺素钠片行促甲状腺激素（thyroid stimulating hormone,TSH）抑制治疗。临床研究发现TSH抑制治疗除对心血管系统和骨骼有严重影响外,对非绝经期女性月经周期有明显影响,常见如月经稀发、月经频发、月经量少、停经、无排卵性月经。现主要就女性甲状腺癌患者术后TSH抑制治疗及其对经期的影响研究进展做一综述。       

分化型甲状腺癌外科治疗的术式选择

目的 :探讨分化型甲状腺癌外科治疗术式的选择。方法 :对 6 6例分化型甲状腺癌病例行患侧腺叶、峡部加对侧次全切除术 49例 ,患侧腺叶及峡部切除术 7例 ,一侧腺叶次全切除及对侧部分切除术 6例 ,全甲状腺切除术 4例。行患侧功能性颈清扫术加对侧功能性颈清扫术 43例 ,双侧功能性颈清扫术 1例及患侧传统性颈清扫术 10例 ,患侧传统性颈清扫术 5例。结果 :3年生存率 96 % (2 5 /2 6 ) ,5年生存率 94% (17/18) ,1例死于白血病 ,1例失访。 4例行全甲状腺切除术的病例术后均出现甲状腺功能减退 ,其中 2例出现甲状旁腺功能减退(5 0 % ) ,其他病例均未发生甲状腺功能和甲状旁腺功能减退。无一例发生喉返神经麻痹。结论 :对分化型甲状腺癌 ,主张行患侧腺叶切除加对侧次全切除或大部切除 ;如术前发现颈淋巴结肿大 ,应同时行患侧淋巴结清扫术。而N0 患者 ,除了对高危组 (男 >41岁 ,女 >5 1岁 )患者腺体外乳头状瘤或明显侵犯包膜的滤泡型腺癌者应行功能性颈清扫术 ,其他随访容易的N0 患者可以不必常规行颈清扫术 ,并提倡长期密切随访。     

晚期甲状腺癌的手术治疗

目的：探讨晚期甲状腺癌的手术治疗效果。方法：11例晚期甲状腺癌患者均行患侧根治性颈淋巴结清扫术，对侧功能性颈淋巴结清扫术；其中3例行患侧甲状腺加峡部切除，6例行患侧甲状腺加峡部加对侧甲状腺近全切除，2例行双侧甲状腺全切除加甲状旁腺埋植术。结果：随访9例，其中死亡1例，为甲状腺乳头状腺癌并甲状腺转移性腺癌患者；8例健在，生存6年、5年各1例，3年2例，2年3例，1年1例，检查未见复发或病灶扩大。结论：对晚期甲状腺癌应尽量争取手术治疗，术后服用甲状腺索能抑制原发灶和转移灶的发展，尽量保存甲状旁腺以提高患者的生活质量。     

隐匿性甲状腺癌的外科治疗

隐匿性甲状腺癌是指肿瘤最大直径不超过1cm的甲状腺癌，又称甲状腺微小癌，大多为乳头状癌，占甲状腺癌的6％～35％。对于隐匿性甲状腺癌的手术范围，目前还没有预测性的临床随机实验来提供明确的治疗指南。因此原发灶的切除范围及颈部淋巴结的清扫范围，成为关注的热点。     

初次甲状腺癌术后声带麻痹模型预测分析

目的 构建初次行甲状腺癌手术患者术后声带麻痹情况的预测模型,预测声带麻痹发生几率。方法 回顾性分析2012年1月—2022年2月收集的394例甲状腺癌患者的临床资料,根据术后有无声带麻痹分为声带麻痹组与无声带麻痹组。根据时间顺序,将2012年1月—2021年5月收集的358例患者作为建模组,2021年6月—2022年2月收集的36例患者作为验证组,运用单因素及多因素,分析两组临床患者基本资料,选择最合适的自变量构建Logistic回归模型,分析甲状腺癌术后声带麻痹的影响因素。内部通过十折交叉验证,外部验证通过比较建模组及验证组的区分度、校准度及临床有效性,绘制受试者工作特征(ROC)曲线、校准曲线及临床决策曲线,评估Logistic回归模型预测价值,计算约登指数、灵敏度、特异度、预测概率P值,根据P=1/1+e^-y,计算出Y值,最后绘制Nomogram图。结果 394例患者均一次完成甲状腺癌手术切除,术后41例患者发生声带麻痹,声带麻痹发生率为10.4%。Logistic回归模型可知喉返神经入喉处是否粘连(OR=11.804,95%CI为3.078~45.273)、术前Tg(OR=0.021,95%CI为0.002~0.202)、是否贴近喉返神经(OR=20.984,95%CI为2.058~214.007)、手术时间(OR=2.768,95%CI为1.122~6.829)是甲状腺癌术后声带麻痹的独立预测因素。十折交叉验证显示ROC曲线下面积为0.7284,建模组ROC曲线下面积为0.794 3(95%CI为0.716~0.872),验证组ROC曲线下面积为0.772 2(95%CI为0.526~1);Hosmer-Lemeshow拟合优度检测显示模型拟合较好,建模组Chi-Square=1.1,P=0.981 6,验证组Chi-Square=3.87,P=0.567 7;约登指数最大为0.188,此时灵敏度为0.57,特异度为0.62,ROC曲线下面积为0.59,P=0.216,为最佳临界值,根据P=1/1+e^-y,此时Y=-1.25。结论 本回归模型预测准确度较好,对甲状腺癌术后预防声带麻痹的发生具有一定的参考意义。     

甲状腺术后疼痛的无创穴位电刺激治疗

目的 探讨甲状腺术后疼痛的无创治疗方法,为甲状腺术后疼痛寻找新的补充治疗。方法 将119名甲状腺术后患者随机分为A、B、C三组,A组使用无创穴位电刺激治疗,B组使用无创穴位电刺激联合药物治疗,C组行药物治疗。记录三组患者术后6h(T1)、术后第1(T2)、2(T3)、3(T4)日使用无创穴位电刺激仪治疗前后的视觉模拟疼痛评分（VAS）,比较三组患者恶心、呕吐的发生情况以及术后24、48、72小时的布氏舒适度评分（BCS）。结果 T1、T2、T3、T4时段A、B两组VAS评分经穴位治疗后明显下降（P<0.05）;三组间VAS评分比较显示B组评分最低,A组与C组间无差异;术后24、48、72小时BCS评分B组最高（P<0.05）,A组与C组间术后早期无明显差异,后期A组高于C组（P<0.05）。结论 无创穴位电刺激治疗与药物治疗无明显差异,均可有效减轻甲状腺术后疼痛,促进术后恢复,联合使用穴位电刺激与药物治疗的镇痛效果更加显著。     

Management of thyroid gland invasion in laryngopharyngeal cancer

BACKGROUND AND OBJECTIVES: The incidence of thyroid gland involvement in laryngopharyngeal cancer ranges from 0 to 23%. Therefore, ipsilateral hemithyroidectomy and isthmusectomy are routinely performed with total laryngectomy in many clinics. Hemithyroidectomy causes hypothyroidism in 63% of patients, and if combined with radiotherapy, the incidence increases to 89% of patients. But there is no consensus about using thyroid surgery in the treatment of laryngopharyngeal cancer. The purpose of this study was to identify criteria to use in the decision of whether, in cases of laryngopharyngeal cancer, hemithyroidectomy should be performed with total laryngectomy. MATERIALS AND METHODS: The study group consisted of 28 patients with a mean age of 63.2 years (range 42-77 years). All patients were treated by thyroidectomy with total laryngectomy. We evaluated the incidence of thyroid gland invasion, clinical predisposing factors, pathologic features, and prognosis in cases of laryngopharyngeal cancer. RESULTS: The incidence of thyroid gland invasion was 14% (4/28). Subglottic extension was the only statistically significant factor in thyroid invasion. All cases of laryngopharyngeal cancer that invaded the thyroid gland had vocal cord fixation, anterior commissure invasion, and were advanced stage. The most common mechanism of spread to the thyroid was by direct extension through thyroid cartilage and anterior commissure. While the prognosis of patients with thyroid gland invasion was worse than that of patients with no invasion, the difference was not statistically significant. CONCLUSION: Prophylactic thyroidectomy should be performed in cases of laryngopharyngeal cancer where there is subglottic extension of the tumor.     

Intraoperative management of the thyroid gland in laryngeal cancer surgery.

OBJECTIVE: To determine if it is necessary to perform a hemithyroidectomy routinely with all total laryngectomies or if it should be reserved for selected cases. DESIGN: A retrospective analysis of 215 cases who had been operated on due to laryngeal cancer in our clinic between 1985 and 1999. SETTING: In only 182 cases, hemithyroidectomy and isthmectomy were performed together with laryngeal surgery. Of these, 98% were male. Their ages ranged between 42 and 70 years. The tumour was located in the supraglottic region in 93 (51%) and in the glottic region in 24 (13%) cases. In 65 cases (36%), the tumour was transglottic. Twenty cases of transglottic tumours (31%) and 3 cases of glottic tumours (12.5%) were found to have subglottic extension. METHODS: Total laryngectomy with unilateral or bilateral neck dissection and hemithyroidectomy on the tumour side plus isthmectomy were performed on all patients. On the pathologic specimens, subglottic extension was measured anteriorly and posteriorly from the free edges of the vocal cords. The specimens were stained with hematoxylin and eosin and examined under a light microscope. MAIN OUTCOME MEASURES: With glottic and transglottic carcinomas, the need for thyroidectomy may be based on the intraoperative assessment of the thyroid gland. In subglottic carcinomas, a hemithyroidectomy should routinely be performed. There may be no need to perform thyroidectomy in all total laryngectomy cases. RESULTS: The thyroid gland was invaded by squamous cell carcinoma in only 2 cases (1%). Both of these cases were transglottic tumours staged as T3 and T4 and had a subglottic extension more than 1 cm. CONCLUSIONS: We recommend routine hemithyroidectomy and isthmectomy during total laryngectomy only in cases with subglottic extensions more than 1 cm or thyroid cartilage invasion with tumour. In the other cases, assessment of extralaryngeal invasion and thyroid gland invasion by the tumour will determine whether thyroidectomy should be performed.     

Pathomorphology of the thyroid gland after treatment of laryngeal cancer

The aim of the report was the explanation of the pathogenesis of thyroid gland dysfunction after laryngeal cancer treatment. Assessment of histopathological specimens from thyroid gland was done. They were taken from the following patients: a) irradiated primary with the radical dose (n = 5), b) after combined therapy (n = 2) and c) at the autopsy from the persons aged between 30-80, without thyroid gland disease history (n = 30). It was found that the thyroid gland underwent degenerative changes after external irradiation or combined therapy, which became more intense with the passage of time. They consist among other things in diminishing of the follicle lining cells with the obliteration of the follicle structure of thyroid, damage to the blood vessel walls, fibrotic tissue proliferation with the following gland atrophy. In the histological specimens of the thyroid gland taken at the autopsy distinct obliteration of the follicle structure with the atrophy of follicle and intensified fibrotic process after 80 years of age was seen. Results of the investigations suggest that the main pathogenic factor in hypotyhyreosis after radiotherapy or combined therapy are the degenerative changes in the thyroid gland and their overlapping with circulatory disorders after surgery. Morphological changes in thyroid gland following aging increase the risk of hypotyhyreosis.     

Warthin-like tumor of the thyroid gland: an uncommon variant of papillary thyroid cancer

Several variants of papillary thyroid cancer have been described, including, most recently, Warthin-like tumor of the thyroid gland. To bring attention to this uncommon variant, we review previous reports on this entity and we add 5 new cases to the literature. We retrospectively reviewed the records of all patients who had undergone thyroidectomy at our institution during a 7-year period. Among these cases, we identified 5 patients who had had a Warthin-like tumor of the thyroid. From their charts, we compiled data on age, sex, lymphadenopathy, distant spread, and treatment. Pathologic specimens were reviewed for tumor size, capsular invasion, and vascular invasion. All 5 patients were women (mean age: 51.6 yr). Tumor size ranged from 0.9 to 2.0 cm. Multifocality was seen in 1 of the 5 patients; this patient was also the only one who experienced capsular and vascular invasion. No patient had lymph node spread or distant metastasis. Because the follow-up period among these patients was still short, we were unable to analyze long-term survival data.     

Myxofibrosarcoma of the thyroid gland

IntroductionMyxofibrosarcoma of the thyroid is exceptional: a Medline search found a single case report. We report a new case which raised diagnostic and therapeutic problems.ObservationWe report the case of a 74-year-old woman who presented with swelling of the left thyroid lobe and ipsilateral cervical lymphadenopathy. Total thyroidectomy with cervical lymph-node dissection was performed. Histological analysis diagnosed myxofibrosarcoma. Evolution was marked by rapid local recurrence, and chemotherapy based on doxorubicin and ifosfamide was introduced.Discussion/conclusionHead and neck myxofibrosarcoma is rare. MRI is essential and should always precede treatment. Diagnosis is histological. There is elevated risk of local recurrence after resection, accompanied by worsening tumor grade, whence the need for accurate diagnosis, appropriate treatment and regular MRI follow-up.     

Leiomyosarcoma of the thyroid gland

The existence of primary thyroid sarcomas represents a contentious issue. Some authors believe that thyroid sarcomas are, in fact, anaplastic carcinomas with sarcomatous (spindle cell) features. From the standpoint of treatment and prognosis, the histogenesis of thyroid 'sarcomas' is academic, because these tumors, irrespective of the therapeutic intervention, are lethal 1. Primary thyroid leiomyosarcomas are extremely rare. Only nine isolated cases have been reported in the literature and such tumors carry a very poor prognosis [1-7] .     

Leiomyosarcoma of the thyroid gland

The existence of primary thyroid sarcomas represents a contentious issue. Some authors believe that thyroid sarcomas are, in fact, anaplastic carcinomas with sarcomatous (spindle cell) features. From the standpoint of treatment and prognosis, the histogenesis of thyroid ‘sarcomas’ is academic, because these tumors, irrespective of the therapeutic intervention, are lethal . Primary thyroid leiomyosarcomas are extremely rare. Only nine isolated cases have been reported in the literature and such tumors carry a very poor prognosis .     

Extraosseous osteosarcoma of the thyroid gland

Extraosseous osteosarcomas are very rare malignant neoplasms that have been published in 300 cases so far. Manifestation within the thyroid gland was described in 6 cases only. We report a 69 year old female who suffered from enlarged recurrent struma after primary resection and radiotherapy 5 years ago. Histology revealed a high grade extraosseous osteosarcoma. Presenting the patient's clinical, radiological and histological findings the therapeutical options of this rare tumor entity are discussed.