甲状舌管囊肿术后复发的多因素分析及手术处理

目的:探讨甲状舌管囊肿术后复发的原因及再次手术的效果.方法:运用统计学软件,采用单因素和logisitic模型分析,分析了12例甲状舌管囊肿术后复发的原因.结果:误诊、感染和不当的手术方法是复发的主要原因,12例复发病人再次手术后,疗效满意.结论:正确的术前诊断,术前抗感染治疗及正确的手术方法可避免术后复发,再次手术是治疗甲状舌管囊肿复发病例的理想方法.     

小儿甲状舌管囊肿82例临床分析

目的通过对117例甲状舌管囊肿中12岁以下小儿病例分析，探讨其临床诊治特点。方法收集与分析临床资料，追踪治疗效果。结果117例中，12岁以下患儿82例，占70.1%；其中4岁以下发生者占48.8%。囊肿位于舌骨下者为62.67%，舌骨水平者17.33%，舌骨以上者为20%；位于颈中线者为81.33%，颈中线偏左者为8%，偏右者为10.67%。手术麻醉多选择基础麻醉加局麻。初次手术者复发率为6.9%。结论甲状舌管囊肿多发生于小儿，囊肿位置可位于舌骨上下，颈中线或偏向一侧。小儿手术麻醉及手术有一定特点，不当手术容易复发。     

甲状舌管乳头状癌诊断及治疗

目的：探讨甲状舌管乳头状癌病例的诊断治疗方法。方法：2例患者术前接受常规体检、B超、细针穿刺检查，手术均包括颈前肿块及舌骨中部的切除(Sistrunk operation)，一侧甲状腺肿块切除或腺叶切除。一例患者由于发现明显右颈肿大淋巴结，故同时实施了功能性颈清扫术。术后标本行常规病理检查。结果：2例患者标本符合甲状舌管乳头状癌诊断，并正在密切随访中。结论：甲状舌管癌为罕见病种，已有公认的诊断标准，Sistrunk手术仍为一种适当的外科治疗方法。     

食管癌术后胸内食管吻合口瘘12例分析

目的：探讨食管癌术后胸内吻合口瘘的原因以及防治方法。方法：采用置管持续冲洗的保守治疗方案。结果：12例中1例二次开胸治愈，其余9例均采用保守治疗方案治愈出院。结论：食管癌术后发生胸内吻合口瘘的原因是多方面的；充分的术前准备，提高手术技巧以及术后正确的治疗方案是降低吻合口瘘的最好办法。     

软组织肉瘤术后复发原因探讨（附33例报告）

目的：探讨软组织肉瘤的术后复发原因及治疗方法。方法：33例软组织肉瘤术后复发病人，结合临床资料，分析其手术方法，术后辅助治疗和软组织肉瘤复发的关系。结果：复发病灶大小：1．5cm*1.5cm*1.0cm-20cm*20cm*18cm；复发时间：术后10天－4年，平均8．2月，术后3月内复发者10例（30．3％）。第1次术后行放疗和（或）化疗者13例（39．4％），未行放疗和（或）＿化疗者20例（60．6％），再次手术者广泛切除术27例，姑息性切除1例，不能手术者5例，结论：软组织肉瘤术后复发的主要原因为手术切除不彻底，术后不积极应用放疗和化疗，术后不进行病理检查或病理诊断错误，树术后复发病人应积极进行再次手术治疗。     

胆总管囊肿的诊治体会与文献综述（附12例报告）

目的：进一步总结胆总管囊肿的诊治经验。方法：回顾性分析了12例胆总管囊肿的临床诊治分析，结合文献综述胆总管囊肿的诊治方法。结果：12例中术前确诊9例(75％)，误诊3例(25％)，均经手术治疗，随访1—10a，再手术2例，恶变1例，行囊肿切除术 肝管空肠吻合病例效果良好。结论：胆总管囊肿确诊后应根据Todani分型行相应的手术治疗，预防囊肿恶变等远期并发症。     

甲状腺癌再次手术62例临床分析

目的 分析甲状腺癌再次手术的原因，探讨分化型甲状腺癌外科治疗术式的选择。方法 回顾分析62例甲状腺癌再次手术的资料，结合文献进行讨论。结果 再次手术原因：①甲状腺癌术前诊断率低，首次手术切除范围不够，致原发癌灶残留；②甲状腺肿瘤复发或颈淋巴结转移；③对侧甲状腺及对侧颈淋巴结出现病灶。结论 由于甲状腺癌的术前误诊，首次手术方式不当，致术后的残癌率高。再次手术是必要的。为避免二次手术，建议常规行术中冰冻病理检查，对不能行术中冰冻病理检查的基层医院或冰冻病理高度怀疑癌的任何单侧甲状腺肿瘤，应至少作患侧甲状腺叶加峡部切除术。对于甲状腺肿瘤切除术后复发或并淋巴结转移者，应积极作合理的再次手术治疗。     

胸腺囊肿的诊断和治疗（附18例）

目的：探讨胸腺囊肿的临床表现、诊断及治疗。方法：回顾分析经病理证实的18例外科治疗的胸腺囊肿,总结临床特点。结果：约56％的胸腺囊肿患者于就诊时无症状,术前确诊率很低,术中、术后无并发症及死亡。随诊3月-20年无复发。结论：胸腺囊肿为一良性病变,术前确诊不易,手术可以消除症状,去除病灶,预后良好。     

原发性腹膜后肿瘤术后复发的诊治

目的:探讨原发性腹膜后肿瘤术后复发的诊断和治疗。方法:回顾性分析1992年来33例原发性腹膜后肿瘤术后复发病例的临床资料。结果:33例中19例进行了再次或多次手术,相应延长了生存时间或减轻了症状。结论:原发性腹膜后肿瘤术后定期随诊,早期发现,充分的术前准备和受累器官的正确估计,是预防再次复发的关键。     

甲状舌管囊肿癌一例报告及文献复习

甲状舌管囊肿较常见,但甲状舌管囊肿癌则十分罕见。文献中迄今报道不足100例,国内尚未见报道。现将我们遇到的一例报告如下: 患者,女性,44岁,因颈部肿物五十余天来诊。肿物最初为枣仁大,无痛,缓慢增大。体检:舌骨上方可触及1.5×1.5×1cm大的肿物,质中等硬,无压痛,与皮肤无粘连,可随吞咽上下活动。按“甲状舌管囊肿”手术。病理检查:标本为一小枣大不规则组     

Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst

BACKGROUND AND OBJECTIVE: Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. METHODS: Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. RESULTS: A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1-456 months), the 5- and 10-year Kaplan-Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P = 0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. CONCLUSIONS: The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment.     

Thyroglossal duct cyst in hyoid bone: Unusual location

A 10-year-old female presenting with a discharging sinus in the midline of the neck of one month duration was diagnosed to have a thyroglossal sinus. She underwent sistrunk’s operation, intra-operatively a thyroglossal duct cyst was atypically sited in the intrahyoid region. The cyst may be located in the intralingual, suprahyoid, thyrohyoid or suprasternal region. A literature search revealed that this intrahyoid location of a thyroglossal duct cyst is extremely rare and so far only three cases have been reported. A case and review of literature regarding this unusual entity are presented.     

Papillary carcinoma in a supra hyoid thyroglossal duct cyst — an unusual presentation

Carcinomatous transformation of ectopic thyroid elements within the thyroglossal tract is a rare entity. We report a case of primary papillary carcinoma of thyroid presenting within the thyroglossal duct cyst in a 23 year old gentleman. The patient presented to us, as a case of suprahyoid thyroglossal cyst with sub-lingual involvement and he underwent surgical excision of the entire thyroglossal tract by Sistrunk’s approach. The post-operative histopathological diagnosis was of a papillary carcinoma within the thyroglossal duct cyst. Hence, the patient was evaluated for a malignant focus in the thyroid which proved negative. He was counseled regarding the possibility of developing Carcinoma in the thyroid gland and offered two options of further management viz., total thyroidectomy followed by life long thyroid suppression or watchful observation and follow up. As the patient belonged to the low risk group, he opted for the second option. He is presently kept under meticulous follow up and remains asymptomatic till date. We present the pre- and post-operative imaging, intra-operative findings, histo-pathological features and review the present world literature on this rare entity.     

Thyroglossal duct cyst papillary carcinoma

Thyroglossal duct cysts are usually located in the midline of the neck. The coexistence of carcinomas in thyroglossal duct cysts is extremely rare, with most being papillary carcinomas. Usually, the diagnosis is only made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate, controversies exist concerning the need for thyroidectomy depending on histopathological findings. We report the case of a 31-year-old man diagnosed with papillary carcinoma within a thyroglossal duct cyst, who underwent total thyroidectomy as has been recommended for differentiated papillary cancer.     

Papillary thyroid carcinoma identified after Sistrunk procedure: report of two cases and review of the literature

Thyroglossal duct cysts represent the most common congenital cervical malformations. Carcinomas arising in the thyroglossal duct cysts are rare neoplasms characterized by a relatively non aggressive behavior with rare lymph node spread. Approximately 1% of thyroglossal cysts contain a carcinoma. The most frequent histological type is papillary carcinoma, accounting for about 80% of cases. Currently, most authors agree about their primary origin ex novo from ectopic thyroid tissue in the cyst. In most cases the diagnosis of thyroglossal duct carcinoma (TDC) is not made until histopathological examination has been performed on a resected cyst without any suspected clinical sign of malignancy. The definition of the correct surgical treatment for these carcinomas is still controversial; most authors maintain that resection of a TDC with the Sistrunk procedure can be considered oncologically adequate when dealing with a differentiated carcinoma without extracapsular invasion and/or lymph node metastases and with a normal thyroid. We present two cases of papillary thyroid carcinoma identified after resection of a thyroglossal cyst according to the Sistrunk procedure and managed with different surgical approaches according to the different sites of the tumors. In addition, we discuss appropriate therapeutic strategies in light of the most recent data in the literature.     

Intrathyroid thyroglossal duct cyst simulating a thyroid nodule

A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.     

Thyroglossal Duct Cyst,Variation in Presentation,Our Experience

Thyroglossal duct cysts are most common midline congenital swelling in head and neck region. It results from incomplete involution of thyroglossal duct. They present as midline painless swelling in neck. We have studied variation in their presentation. The retrospective study carried out in department of ENT in Gandhi Medical College Bhopal from Jan 2009 to Sept 2013. Objective of this study is, to study incidence of Thyroglossal Duct Cyst in different age and sex group and variation in presentation. Clinical records, medical records and histopathological records were studied. 10 patients diagnosed as Thyroglossal Duct Cyst included in study. 10 patients were found to be diagnosed as Thyroglossal Duct Cyst. Out of 10 pt. 6 were pediatric patients and 4 were adults. 8 patients presented with cyst while 2 presented with fistula. Out of 10 patients 3 presented with suprahyoid, 2 at the level of hyoid and 5 had infrahyoid presentation. 7 patients undergone sistrunk operation procedure while 3 undergone simple excision. Out of 3 patients who undergone simple excision 1 patient develop recurrence. Thyroglossal Duct Cyst are one of the most common asymptomatic midline neck swelling and should be differentiated with other swellings with proper investigations.     

Papillary carcinoma of thyroglossal cyst

Malignancy of thyroglossal cyst is a rare entity. Medical literature has reported only a very few cases till date. Histopathologically papillary carcinoma of thyroglossal cyst is the most common variety encountered in clinical practice. Surgical excision by Sistrunk operation is the standard treatment of choice followed by subtotal or total thyroidectomy whenever indicated. We report here two cases of thyroglossal cyst carcinomas and their respective management.     

关节镜治疗窝囊肿分析

目的探讨关节镜下治疗窝囊肿的方法及临床疗效.方法对48例MRI提示囊肿与后关节囊相通的窝囊肿(直径小于5cm)患者分成两组,26例采用关节镜下清理与后内侧间室扩大窝囊肿与关节腔之间的通道口,22例采用常规开放手术切除并结扎囊肿蒂部.根据Rauschning和Lindgren分级方法和膝关节MRI评定手术疗效.结果关节镜组术后平均住院时间、切口瘢痕大小、下地活动时间及复发率明显优于常规手术组.48例患者术后均获随访,随访时间为15-31个月,平均25个月.常规手术组有4例复发,关节镜组仅1例严重骨关节炎患者术后复发,后予全膝关节置换术后痊愈.Rauschning和Lindgren分级结果术前与术后两组差异无统计学意义(P＞0.05).结论关节镜下治疗窝囊肿具有创伤小、恢复快、复发率低的优点.     

单孔腹腔镜行囊肿剔除术治疗卵巢巨大囊肿的临床分析

目的:探讨应用单孔腹腔镜行囊肿剔除术治疗卵巢巨大囊肿的安全性及可行性。方法:回顾性分析我院2017年6月至2018 年6月收治的卵巢巨大囊肿患者71例（直径≥12 cm）,按手术途径分为研究组34例（应用单孔腹腔镜行囊肿剔除术）和对照组37例（应用传统腹腔镜行囊肿剔除术）。比较两组患者手术时间、术中出血量、术中囊液外漏率、术后24 h疼痛评分、术后排气时间、首次离床时间、术后并发症发生率、术后住院时间及住院费用等临床指标。结果:研究组和对照组患者术中囊液外漏率分别为2.9%和18.9%;在巧囊组患者中,手术时间及术中出血量两组比较差异无统计学意义;在非巧囊组患者中,研究组手术时间及术中出血量较对照组明显减少,差异有统计学意义（P＜0.05）;两组患者均无并发症发生;研究组术后排气时间、首次离床时间明显早于对照组,且术后24 h疼痛评分低,术后住院时间短,住院费用低,差异有统计学意义（P＜0.05）。结论:在严格选择病例的前提条件下,单孔腹腔镜治疗卵巢巨大囊肿能减少囊液外漏率,减轻患者术后疼痛,促进肠道功能恢复,缩短住院时间,不增加并发症发生率及住院费用,是安全有效的。