Prospective Identification of Chyle Leakage in Patients Undergoing Lateral Neck Dissection for Metastatic Thyroid Cancer

Background Lateral neck dissection for metastatic thyroid cancer includes the lower jugular nodes, but there has been little study of chyle leakage. We therefore prospectively examined chyle leakage that occurred during and after lateral neck dissection in treatment of thyroid cancer. Methods A total of 82 consecutive patients underwent 96 lateral neck dissections for metastatic differentiated thyroid cancer—42 in the right neck, 26 in the left neck, and 14 in both. All patients were monitored for intraoperative and postoperative chyle leakage. All postoperative drainage fluid and serum were chemically analyzed for triglycerides and cholesterol for early identification of chyle leakage. Results Intraoperative chyle leakage was observed during 5 of the 96 neck dissections (5.2%), all on the left side and all controlled by suturing chyle fistula, thus avoiding postoperative leakage. Postoperative chyle leakage was observed in 8 of the 96 neck dissections (8.3%), 5 in the right and 3 in the left neck. The mean peak triglyceride concentration of drainage fluid was significantly higher in patients with chyle leakage than in those without (309 vs 42 mg/dl, P < 0.001). To stop leakage, 2 patients underwent reoperations. Chyle leakage stopped within 5–62 days (mean 18 days) after surgery. Conclusions Chyle leakage related to lateral neck dissection for thyroid cancer is uncommon but may occur more frequently than reported previously, even in the right neck. Our findings may guide thyroid surgeons in both careful neck dissection in at-risk areas and proper postoperative management.     

Chyle Leakage in Patients Undergoing Thyroidectomy Plus Central Neck Dissection for Differentiated Papillary Thyroid Carcinoma

Background  Chyle leakage is an uncommon complication of lateral neck dissection for metastatic papillary thyroid carcinoma (PTC). There have been no reports on chyle leakage after central neck dissection not combined with lateral neck dissection. We therefore investigated chyle leakage in PTC patients undergoing thyroidectomy and central neck dissection. Methods  A total of 283 new patients with differentiated PTC underwent total thyroidectomy plus central neck dissection. The amount and duration of drain leakage, and the concentrations of triglycerides and cholesterol in drain fluid and serum were measured in patients who had suspected postoperative chyle leakage. The incidence and management of chyle leakage were analyzed. Results  Intraoperative chyle leakage was not found in any patient, although postoperative leakage was detected in four patients (1.4%). Mean ± standard deviation peak 24-hour drainage was 122 ± 57 mL, and duration of leakage was 10 ± 7 days. Mean triglyceride concentration of drainage fluid was 433 ± 182 mg/dL. These patients were treated with pressure dressings and a medium-chain triglyceride diet. One patient underwent intralesional injection of OK-432 for localized chyle accumulation. All chyle leakages stopped after conservative management without surgical intervention. Conclusion  Chyle leakage can occur after thyroidectomy and central neck dissection not combined with lateral neck dissection. These findings will aid in the recognition and treatment of this uncommon complication during the early postoperative period.     

甲状腺癌双侧颈淋巴清扫术的临床研究

目的探讨甲状腺癌双侧颈淋巴结清扫术及甲状腺肿瘤切除术的疗效。方法11例甲状腺癌患者,2例双侧者行甲状腺近全切除,单侧的9例均行患侧甲状腺叶及峡部全切除,7例附加对侧腺叶次全切除。所有病例均行功能性双侧颈淋巴结清扫术。结果TNM分期:T4N1M11例,T4N1bM07例,T3N1bM02例,T3N0M01例。10例双侧有淋巴结转移,1例双侧均阴性。3例术后出现一过性甲状腺功能低下,补钙后缓解,3周后恢复正常;1例颜面水肿,2周内消退。无喉返神经麻痹等严重并发症。随访3~7年,仅2例复发,经I131放疗后得以控制。所有患者均健在。结论对Ⅲ期甲状腺癌进行同期功能性颈淋巴结清扫术不仅达到根治性切除的目的,而且术后颈部外形和功能恢复更为满意,提高了病人的生活质量。     

甲状腺癌改良根治性颈淋巴结清扫术

全麻甲状腺全切+左Ⅱ~Ⅳ区淋巴清扫+中央区淋巴清扫+左侧喉返神经吻合术。切断左胸骨甲状肌上端,辨认喉上神经外支后,切断甲状腺上血管,沿真被膜解离,下极处辨认喉返神经后处理血管,注意保护上下旁腺。全长暴露左侧胸锁乳突肌深面,切开左侧颈鞘,保护副神经,自下而上,自前向后,清扫左侧Ⅱ-Ⅳ区淋巴结,在左侧颈静脉角处注意结扎,防止术后乳糜漏。     

甲状腺癌颈淋巴结清扫术后乳糜漏的防治（附19例报道）

目的 探讨临床上更加有效地预防和治疗颈乳糜漏的方法 .方法 我科1988～2008年期间共收治593例行甲状腺癌颈淋巴结清扫术的患者,对术后出现乳糜漏的患者的临床资料进行总结分析.结果 共出现颈乳糜漏19例,占3.2%,其中17例采用持续负压吸引加局部加压包扎的保守治疗方法 治愈,2例采用淋巴管缝扎方法 治愈.结论 持续负压吸引加局部加压包扎是治疗甲状腺癌颈淋巴结清扫术后乳糜漏的主要治疗方法 ,对于引流量较大、持续时间较长的病例应采用手术治疗的方法 .     

多保留功能性颈淋巴结清扫在甲状腺乳头状癌手术中的应用

目的探讨多保留功能性颈淋巴结清扫术在甲状腺乳头状癌手术中的应用价值。方法回顾性分析21例甲状腺乳头状癌手术中行多保留功能性颈淋巴结清扫术患者的临床资料。结果21例共清扫淋巴结485枚,颈淋巴结转移率66．0％（320／485）;声音嘶哑2例;术后颈丛功能满意,颈部肌肉无僵硬萎缩,无肩下垂、抬肩无力及肩部疼痛,亦无耳后、肩部感觉障碍和面部水肿。均获随访,平均4（1～7）年;颈部复发1例,肺转移、全身多发转移各1例,无死亡病例。结论多保留功能性颈淋巴结清扫术在甲状腺乳头状癌手术中作用确切,在彻底清扫颈淋巴结的同时能更好地保留患者颈部功能及外形,避免术后颈面部水肿及感觉异常。但对于颈部淋巴结广泛转移且淋巴结较大,肿瘤外侵明显的不在该手术考虑范嗣内。     

合并转移的甲状腺微小癌诊治(附16例分析)

目的：探讨合并转移的甲状腺微小癌的危害性及其诊断和治疗。方法：总结我科１９７８～２０００年收治的合并转移的甲状腺微小癌１６例,结合文献进行临床分析。结果：术中及住院期间无一死亡。５例发生术后转移（３１.２５％）,远处转移为主,与同期无转移的甲状腺微小癌９２例相比（仅２例复发）,具有明显统计学意义上的差别（Ｐ＜０．００１）。病理切片结果提示本组资料的癌灶均已穿透包膜,存在包膜外血管浸润。其中７例因远处转移于术后５年内死亡。结论：应高度重视本病的危害性。掌握本病的临床特点,甲状腺Ｂ超检查结合转移灶穿刺活检可提高其诊断率。手术为首选治疗方法。术后可辅以甲状腺素Ｉ同位素或化疗等治疗。     

Thyroid Tuberculosis Mimicking Carcinoma: Report of Two Cases

Among 527 patients with thyroid disease who underwent surgery at our hospital during a 20-year period, 2 (0.4%) had tuberculous thyroiditis mimicking carcinoma. The first patient was a 44-year-old man with a solitary thyroid nodule and the second was a 24-year old man with a thyroid abscess. The unexpected diagnosis was made postoperatively and was based on histological findings in both patients. No primary focus was found elsewhere in either patient, and both responded to antituberculous chemotherapy. Although the diagnosis is usually based on examination of resected specimens, recent reports indicate that find-needle aspiration cytology is a cost-effective technique of diagnosing thyroid tuberculosis. A review of 35 cases reported in the English literature is also discussed.     

乳腺癌腋窝淋巴结解剖术(附169例分析)

目的总结乳腺癌腋窝淋巴结解剖术(axillary lymph node dissection,ALND)的手术方法和经验。方法回顾性分析原发性乳腺癌行ALND的169例临床资料。结果本组163例行Ⅰ、Ⅱ平面解剖术,6例行Ⅰ～Ⅲ平面解剖术。切除标本共检出淋巴结4273枚;每例10～69枚,平均(25.28±10.23)枚。术后切口感染3例(1.78%),经引流治愈;患侧上肢水肿4例(2.37%),其中3例为切除Ⅲ平面淋巴结患者,1例为切除Ⅰ、Ⅱ平面淋巴结患者;腋窝淋巴漏1例(0.59%),为切除Ⅲ平面淋巴结病例;患侧上臂内侧及背侧皮肤麻木14例(8.28%),患侧胸肌萎缩5例(2.96%),多发生在先期诊治病例(1999年12月前)或切除Ⅲ平面淋巴结病例。结论ALND要求应用精细解剖技术,切除Ⅰ、Ⅱ平面淋巴结即可,人为扩大手术范围会增加特异性并发症发生率。     

Sarcoidosis Presenting as Cold Thyroid Nodules: Report of Two Cases

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.     

Crank-Shaped Sternotomy for Upper Mediastinal Lymph Node Dissection in Patients with Differentiated Thyroid Cancer

We describe our modification of the reversed T-shaped sternotomy. The conventional technique consists of a limited upper sternotomy with transverse division of the sternum. Our modification involves shifting the transverse division lines one costal space between the right and left sides for perfect apposition of the divided upper and lower sternum. This technique can be used for patients with thyroid cancer and mediastinal lymph node metastasis and for those with a mediastinal tumor or certain cardiac disorders.     

早期胃癌内镜黏膜下剥离术后追加手术的原因分析

目的探讨早期胃癌内镜黏膜下剥离(endoscopic submucosal dissection,ESD)术后追加外科手术的原因。方法回顾性分析2015年1月~2019年8月ESD术后追加手术的23例早期胃癌共25处病灶的临床病理资料,包括内镜下表现、ESD病理结果及手术病理结果。结果早期胃癌ESD术后追加手术的原因有病灶侵犯黏膜下层19处(76%),分化类型差16处(64%),脉管内瘤栓8处(32%),阳性切缘9处(36%)。追加外科手术后病理提示肿瘤残留2例,淋巴结转移1例。随访2~53个月,中位数17个月,无复发及死亡。结论侵犯黏膜下层、分化类型差、脉管内侵犯以及基底切缘阳性是早期胃癌ESD术后追加手术的主要原因。     

Brachiocephalic Vein Thrombus of Papillary Thyroid Cancer: Report of a Case

Differentiated thyroid cancer sometimes shows microscopic vascular invasion but rarely causes a tumor thrombus in a great vein. A preoperative diagnosis of the latter condition is difficult if a patient does not have any overt symptoms, but it is important for operative planning. We encountered a 26-year-old woman with papillary thyroid cancer and a tumor thrombus extending from the brachiocephalic vein to the superior vena cava. The tumor was successfully treated by surgical resection. To our knowledge only 19 such cases have so far been reported. We herein report our case, review the literature, and discuss the associated diagnostic problems and treatments including such areas as age, gender, symptoms, pathology, extension, and outcome. Received: October 20, 2000 / Accepted: July 17, 2001     

分化型甲状腺癌术中纳米碳示踪对颈淋巴结清扫的指导意义

分化型甲状腺癌是临床最为常见的恶性肿瘤之一,完整的外科手术切除是决定预后的重要因素,残余的转移淋巴结是术后复发的高危因素,淋巴结的彻底清扫可以改善总体预后。然而对于甲状腺癌的预防性/治疗性颈淋巴结清扫术尚存争议及挑战。纳±3碳混悬液作为新型的淋巴结示踪剂,对于甲状腺的淋巴结具有良好的示踪效果,可以显著提高术中的清扫效率,增加获取淋巴结的数目,更为准确地判断分期及预后。另外通过其"负显影"的特性可以有效保护喉返神经、甲状旁腺等重要结构,显著降低颈部淋巴结清扫中并发症的发生率,具有重要的临床意义。     

Late Complications Following Surgery for Type A Acute Aortic Dissection Using Gelatin-Resorcin-Formaldehyde Glue: Report of Two Cases

Gelatin-resorcin-formaldehyde (GRF) glue has been widely applied during operations for acute aortic dissection (AAD). At our institution, GRF glue was applied in 40 patients who underwent surgical procedures for AAD from 1995, two of whom needed a reoperation because of the development of a redissection and/or a pseudoaneurysm at the anastomotic sites. The operative findings and histological examinations suggested that the application of GRF glue during the initial operations might be related to the development of a redissection and/or a pseudoaneurysm.     

Liver Metastasis from Thyroid Carcinoma 32 Years After Resection of the Primary Tumor: Report of a Case

Follicular thyroid carcinoma is a differentiated cancer originating from the follicular cells in the thyroid gland. A 73-year-old woman, who had undergone curative resection of thyroid carcinoma 32 years earlier, was referred to our hospital after ultrasonography showed a solid mass in the liver. Laboratory data revealed positive hepatitis B core antibody, but all other values were normal. Computed tomography showed a round tumor, about 1.5cm in diameter, which was enhanced early and washed out later, in segment 5 of the liver. She underwent laparotomy and partial resection of the liver. Microscopic examination showed follicular cells with minimal atypia growing in a thyroid follicular pattern with colloids, whereby a diagnosis of metastatic liver cancer from thyroid follicular carcinoma was made. This is a rare case of solitary liver metastasis appearing 32 years after eradication of primary follicular carcinoma. Although the reason for the delayed presentation of the metastatic lesion remains unclear, this case shows that patients with differentiated thyroid cancer should be followed up for their entire life.     

Adverse Tissue Reactions in Modular Exchangeable Neck Implants: A Report of Two Cases

Dual-modular femoral stems with exchangeable necks theoretically allow optimization of hip joint biomechanics via selective restoration of femoral anteversion, offset, and limb length. A potential disadvantage is the possible generation of metal ions and debris by fretting and crevice corrosion at the additional stem-neck interface. We present 2 cases of early-onset adverse inflammatory tissue reactions as a result of accelerated corrosion at the stem-neck interface of a dual-modular implant, requiring subsequent revision of well-fixed components.