甲状腺全切除和次全切除术对甲状腺癌的治疗效果及安全性的比较

目的 采取甲状腺全切除及次全切除治疗甲状腺癌,分析其治疗效果及安全性.方法 对所选的甲状腺癌患者采取甲状腺全切除术及次全切除术,观察对比2组患者的手术情况、术后情况、并发症、治疗效果.结果 次全切除组手术时间(33.12±10.10) main、切口长度(3.12±0.21)cm、术后出血量(25.31 ±4.23) ml、术后住院时间(6.32±1.03)d、术后镇痛时间(12.43±2.91)h,与全切除组比较,均明显减少,差异有统计学意义(P＜0.05).全切除组出现喉返神经损伤5％,呼吸困难10％,声音嘶哑15％,低钙血症15％,并发症总发生率45％,均明显高于次全切除组,差异均有统计学意义(P＜0.05).全切除组的切口满意占40％,次全切除组切口满意占95％,差异有统计学意义(P＜0.05).2组患者术后12 h、24 h疼痛评分、术后复发率无明显差异(P＞0.05).结论 甲状腺次全切除术治疗甲状腺癌,能够缩短手术时间,减少术中出血量,减少住院时间及镇痛时间,降低术后并发症发生率,缩小手术切口范围,提高了患者的生活质量,安全有效.     

Completion thyroidectomy for differentiated thyroid carcinoma

Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total or near-total thyroidectomy. The extent of surgical management for differentiated thyroid carcinoma (DTC) is controversial. Although some authors advocate subtotal thyroidectomy with lower complication rates, total or near-total thyroidectomy and completion thyroidectomy have been defended by others because of the improved survival and lower morbidity that is comparable with subtotal thyroidectomy. In this study, the incidence of residual tumor and surgical complication rates in patients who underwent completion thyroidectomy were investigated. The medical records of 165 patients undergoing completion thyroidectomy for DTC were reviewed. Seventyseven (46.6%) of these patients were found to have residual tumor in the remaining thyroid tissue. Anaplastic transformation developed in two of these patients. Permanent bilateral recurrent laryngeal nerve palsy occurred in three patients, and permanent hypoparathyroidism was seen in one patient. We recommend completion thyroidectomy as an efficient and safe method of surgical treatment with a low complication rate for DTC.     

The impact of completion thyroidectomy

IntroductionThe oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to the impact of the overall treatment.The aim of this study is to assess the impact of CT in terms of the duration of admission and associated complications.MethodsA study of consecutive patients with DTC identified from prospective MDT records of South-East Scotland from 2009 to 2015. Surgical data was extracted from electronic medical record.ResultsOf 361 patients diagnosed with DTC, 161 (45%) had CT. The median postoperative stay was 1 day (range 1–5days). In total 22 patients (14%)suffered complications. Four patients (3%) developed postoperative haematoma. Two (1%) had an identified permanent nerve palsy on the completion side. 13 patients (8%) remained on calcium supplementation for more than 6 months postoperatively and three patients (2%) developed wound complications.ConclusionsOur study confirms that CT is regularly performed (45%). Recent changes in international guidelines recognize increasing number of patients as eligible for a conservative approach but recommend CT based on whether upfront TT would have been recommended if the TL pathology were known from the outset. Such an approach fails to consider the additional risk and inconvenience of CT on the overall patient experience.Due to a relatively high rate of complications, only those patients who are most likely to benefit from further surgery to facilitate adjuvant radioactive iodine should be offered additional surgery.     

甲状腺全切除术在分化型甲状腺癌外科治疗中的应用价值

目的 探讨甲状腺全切除术在甲状腺癌外科治疗中的应用价值.方法 对60例分化型甲状腺癌患者的临床资料进行回顾性分析和总结,其中采用甲状腺全切除术的患者48例,采用甲状腺次全切除术的患者12例.结果 48例进行甲状腺全切除术的患者术后发生低钙及声嘶5例(10.42％),1年间甲状腺癌复发1例(2.08％);12例采用甲状腺次全切除术的患者术后发生低钙及声嘶6例(50.00％),1年间甲状腺癌复发5例(41.67％).采用甲状腺次全切除术治疗的患者更易出现术后并发症(P =0.042),且1年间甲状腺癌的复发率更高.结论 甲状腺全切除术是治疗分化型甲状腺癌的一种有效方式,但采用甲状腺全切除术对患者进行治疗时要预防并发症的发生.     

Extended Surgical Implication of Tubercle of Zuckerkandl in Total Thyroidectomy

The primary objective of the study was to assess the Tubercle of zuckerkandl (TZ) during thyroid surgeries and its relationship with RLN and Superior parathyroid (SP). A prospective study was done in, 30 consecutive cases of total thyroidectomy in whom per operatively TZ was identified. The presence of TZ, its laterality, size, relationship with RLN and parathyroid glands were documented. A grading system outlined by Pelizzo was applied in our current study. In majority of the cases the RLN was found to lie medial to TZ (26/30), followed by lateral position (3/30) and one case it was found to be posterior to TZ (1/30). The superior parathyroid was identified in close relation (< 2 cm) to the TZ in 27/30 cases. The distance between the TZ and SP was assessed. We proposed a classification for location of SP based on the distance between SP and TZ and also attempted to relate each class of SP location with TZ grade. There was strong association of Grade of TZ with the class of SP location (p value = 0.00046). TZ is constant surgical landmark with good reliability to identify the RLN and SP. RLN is found medial to TZ in majority of cases with few exceptions. SP is found to be closely associated with TZ in majority of cases and there is a strong relationship of proximity of SP and TZ with respect to TZ grade. Although this required further studies with larger population.     

甲状腺全切除术治疗双侧结节性甲状腺肿的临床效果

目的探讨甲状腺全切除术诊治双侧结节性甲状腺肿的临床意义。方法接受双侧结节性甲状腺肿治疗的患者75例,依照不同的手术方式将其分为甲状腺次全切除组38例,甲状腺全切除组37例,对2组患者手术情况及术后并发症、复发率进行比较。结果全切除组手术时间(130.23±45.26)min,明显长于次全切除组的(104.63±20.50)min,差异有统计学意义(P<0.05);全切除组的住院时间(7.5±2.5)天,与次全切除组的(6.8±2.3)天比较,差异无统计学意义(P>0.05)。次全切除组患者复发率21.05%,显著高于全切除组患者0,差异有统计学意义(P<0.05)。结论在双侧结节性甲状腺肿的手术治疗中,甲状腺全切除手术更具有优势,疗效显著,结节复发率低,也不会增加术后并发症的发生率,是一种临床上值得推广的治疗双侧结节性甲状腺肿的手术方式。     

Completion pneumonectomy for lung metastases

OBJECTIVE: Completion pneumonectomy (CP) for malignant disease is generally accepted but controversial for lung metastases. The data available show a high perioperative morbidity and mortality with a poor long-term prognosis. We analysed the postoperative outcome and long-term results of our patients undergoing CP. PATIENTS AND METHODS: Between January 1986 and May 2003, nine patients underwent completion pneumonectomy for lung metastases. This represents 10% (9/86) of all CPs performed and 1.7% (9/525) of all pneumonectomies. RESULTS: One to three metastasectomies in the form of wedge resection (16), segment resection (5) and lobectomies (3) were performed prior to CP. The mean time interval between the operation of the primary tumour and the first metastasectomy was 38 months, the first and second metastasectomy 12 months, the second and third metastasectomy 14 months, and the third metastasectomy and CP 25 months. Six patients had an extended completion pneumonectomy. Operative morbidity and mortality was 0%. One patient is still alive and recurrence-free 9 months after CP. Two patients have recurrent pulmonary contralateral metastases under chemotherapy and six patients died of metastatic disease. Actual survival is 33%, recurrence-free survival (RFS) is 11%. The 3-year survival is 34%. CONCLUSION: Since there was no morbidity and mortality in our series, CP for lung metastases seems to be justified but the long-term survival is limited by the occurrence of contralateral or extrapulmonary metastatic disease. Multiple resections of metastases have a positive influence on survival, but the last step of resection in the form of CP does not seem to improve long-term survival.     

Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy for Endometrial Cancer: A Meta-analysis

The standard surgery for early-stage endometrial cancer is total abdominal hysterectomy (TAH), while totallaparoscopic hysterectomy (TLH) is less invasive and assumed to be associated with lower morbidity. This metaanalysiswas performed to investigate the effects of TLH versus TAH in women with early-stage endometrialcancer. We searched the PubMed, EMBASE, CBM and Cochrane Review databases for randomized trialsassessing the effects of TLH versus TAH in women with early-stage endometrial cancer. The relative risks (RR)with 95% confidence intervals (CIs) from each study were pooled using meta-analysis. In our study, 9 randomizedtrials with a total of 1,263 patients were included. Meta-analyses showed that TLH was associated with lowerrisks of major complications (RR = 0.53, 95%CI 0.29-0.98, P = 0.042), total complications (RR = 0.59, 95%CI0.42-0.82, P = 0.002) and postoperative complications (RR = 0.57, 95%CI 0.40-0.83, P = 0.003). However, therewere no obvious differences in risks of intra-operative complications (RR = 0.98, 95%CI 0.62-1.55, P = 0.919)and mortality (RR = 0.96, 95%CI 0.66-1.40, P = 0.835). In conclusion, our results provide new evidence of abenefit for TLH over TAH in terms of major complications, total complications and postoperative complicationsin endometrial cancer patients.     

Health-Related Quality of Life following Total Thyroidectomy and Lobectomy for Differentiated Thyroid Carcinoma: A Systematic Review

Health-related quality of life (HrQoL) is a major concern for patients with differentiated thyroid carcinoma (DTC). We aimed to systematically review the literature comparing HrQol following total thyroidectomy (TT) and hemithyroidectomy (HT) in DTC patients. A systematic review of publications indexed in Medline, Embase, and EBM reviews—Cochrane Central Register of Controlled Trials, which evaluated HrQoL following thyroid surgery for DTC, was conducted. Of 2507 identified records, 25 fulfilled the inclusion criteria. Our results suggest that patients undergoing TT may suffer more impairment in physical and social HrQoL than patients undergoing HT. Psychological-related HrQoL and long-term global HrQoL are, however, equivalent in both groups, which highlights the multidimensional nature of HrQoL and the importance of a multitude of factors aside from treatment modalities and related morbidities, such as the experience of receiving a cancer diagnosis, the fear of cancer recurrence, and other psychosocial factors. Addressing postoperative HrQoL when discussing therapeutic options with patients is an integral part of patient-centered care and informed shared decision-making, and should be approached in a holistic manner, accounting for its physical, psychological, and social aspects. This review supplies evidence regarding HrQoL following thyroid surgery, which can be employed in such decisions.     

甲状腺全切除术治疗分化型甲状腺癌(附72例)

目的:探讨甲状腺全切除术治疗分化型甲状腺癌安全性的相关因素。方法:回顾性分析本院2002年1月至2010年1月期间72例甲状腺全切术治疗分化型甲状腺癌的病历资料,分析甲状旁腺功能减退和喉返神经损伤的发生情况。结果:甲状旁腺功能减退发生与再次手术、原发肿瘤腺体外侵犯、中央区淋巴结转移有关,与是否行颈清无关;喉返神经的损伤与上述因素无关。结论:影响甲状腺全切术治疗分化型甲状腺癌安全性的相关因素有:手术次数、原发肿瘤腺体外侵犯和中央区淋巴结转移。     

纳米碳甲状旁腺负显影技术在甲状腺癌根治术中的应用

[目的]研究纳米碳甲状旁腺负显影技术在甲状腺癌根治术中的应用.[方法]分析118例甲状腺癌患者的临床资料,随机分为研究组(60例)和对照组(58例),研究组术中注射纳米碳混悬液.对两组患者的血钙、甲状旁腺素水平进行比较分析.[结果]研究组甲状旁腺误切率为1.7％,对照组为5.2％(P=-0.587);一过性低钙血症发生率分别为3.3％和15.5％(P=-0.023);永久性低钙血症发生率分别为0和1.7％(P=0.492);PTH暂时性减低发生率分别为3.3％和12.0％(P=0.140);PTH永久性减低发生率分别为0和1.7％低(P=0.492).[结论]纳米碳甲状旁腺负显影技术在甲状腺癌根治术尤其双侧甲状腺全切除术中可有效保护甲状旁腺.     

补充性全肺切除术对残肺病变的治疗价值

目的：评估补充性全肺切除术的适应证、危险性和结果。方法：回顾性分析６８例年龄在１５￣７１岁的残肺良恶性病变的患者的补充性全肺切除术,其中第二肺癌１７例,肺复发癌３２例,良性肺及胸膜疾患１９例。再次手术间隔期为恶性者２９个月,良性为２１７个月。结果：７例患者死亡（１０．４％）,２例死于术中,５例死于术后,癌性患者死亡率（１１．６％）高于良性患者（５．９％）。全部病例５年生存率为４８％,癌症患者３３％     

低位小切口切除术治疗甲状腺瘤的疗效及安全性分析

目的 探讨低位小切口切除术治疗甲状腺瘤的临床疗效及安全性.方法 将150例甲状腺瘤患者根据随机数字法分为对照组(传统手术切除术)和观察组(低位小切口切除术),每组各75例,比较2组术中、术后情况,以及并发症发生情况.结果 与对照组相比,观察组切口大小、手术时间、术中出血量均明显减少,P＜0.05;与对照组相比,观察组术后48 h引流量、住院时间均明显减少,美观评分明显增高,P＜0.05.与对照组相比,观察组颈区感觉异常、疼痛,切口粘连,皮下结节,吞咽不便等并发症发生率均显著降低,P ＜0.05.结论 低位小切口切除术治疗甲状腺瘤具有疗效显著、恢复快、并发症少、安全性高等特点,值得临床推广.     

Construction and validation of nomograms to reduce completion thyroidectomy by predicting lymph node metastasis in low-risk papillary thyroid carcinoma

ContextMore than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma (PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing lobectomy.ObjectiveTo screen potentially high-risk patients from low-risk patients by using preoperative and intraoperative clinicopathological features to predict lymph node status.MethodsA retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009–2021) was performed according to the 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression and best subsets regression were used to identify risk factors. Nomograms were established and externally validated using the Differentiated Thyroid Cancer in China cohort.ResultsMore than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node (all p < 0.05) were established. The nomogram based on NCCN criteria showed better discriminative power and consistency with a specificity of 0.706 and a sensitivity of 0.725, and external validation indicated that 76% of potentially high-risk patients could achieve preoperative conversion of surgical strategy.ConclusionsModels based on large cohorts with good predictive performance were constructed and validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years, male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce CTx.     

胸乳腔镜下甲状腺癌切除术与传统手术临床治疗效果对比分析

目的：对比分析胸乳腔镜下甲状腺癌切除术与传统手术的临床治疗效果。方法将84例甲状腺癌患者随机分为对照组与试验组。对照组采用传统手术,试验组采用胸乳腔镜术,对比分析2组患者临床治疗效果。结果与对照组相比,试验组手术时间较长,但术中出血量、术后引流量、插管时间以及住院时间明显少于对照组,差异有统计学意义（P＜0．05）。试验组与对照组相比,术后并发症的发生率上差异不具统计学意义（P＞0．05）。试验组患者术后的满意度评分较好,尤其7～10分患者比例数显著高于对照组;术后3个月以及术后6个月2组患者的NSS评分差异具有统计学意义（P＜0．05）。结论胸乳腔镜下甲状腺癌切除术的临床效果显著,可广泛推广于临床。     

结节性甲状腺肿与甲状腺癌的关系以及甲状腺切除术后复发的原因

目的 探讨结节性甲状腺肿与甲状腺癌的关系以及甲状腺切除术后复发的原因.方法 选择甲状腺结节患者,一共260例,回顾性分析患者术后复发有关的因素.结果 良性结节性甲状腺肿235例,伴有乳头状增生35例,占14.89％;伴有非典型增生30例,占12.77％,伴有癌变均为微小癌5例,占2.13％.甲状腺癌25例,其中乳头状癌15例,占甲状腺癌60％;滤泡癌5例,占20％;髓样癌1例,占4％,未分化癌4例,占16％.甲状腺癌周围组织伴有结节性甲状腺肿病变为20例,占甲状腺癌的80％.随访期间复发病例一共20例,占7.69％.肿瘤大小、手术方式、病理类型、是否行淋巴结清扫与术后复发具有显著相关性.影响手术预后情况的独立因素包括肿瘤最大直径>4 cm、手术方式为单侧腺叶加峡部切除、病理类型为未分化癌、未作淋巴结清扫.结论 结节性甲状腺肿是甲状腺癌的癌前病变,甲状腺切除术后患者复发的危险因素广泛而复杂.