甲亢术后复发再手术治疗41例临床分析

目的探讨甲状腺功能亢进症术后复发的原因、再手术治疗的适应证及手术方法。方法回顾性分析1985年1月。2004年3月41例甲状腺功能亢进症术后复发再手术治疗的临床资料。结果41例经再手术全部治愈。结论腺体残留过多是甲状腺功能亢进症术后复发的主要原因，有选择地再手术是治疗甲状腺功能亢进症术后复发的有效治疗方法。     

甲状腺术后并发症的预防及护理

目的：探讨甲状腺手术术后并发症的预防方法及护理。方法：对108例甲状腺疾病患者行甲状腺手术的资料进行回顾性分析。结果：发生各种并发症4例,发病率3.7%。发生喉神经、喉上神经损伤各1例（分别为甲状腺癌根治术和甲亢患者）,甲状腺危象1例。1例单侧喉返神经暂时性损伤,半年后随访声音恢复。结论：手术是治疗甲状腺疾病的主要方法,有效的术前准备和术后护理是防止术后严重并发症的有效手段。     

甲状腺疾病不同手术方式的术后并发症分析

目的探讨不同甲状腺疾病手术方式的选择及其术后并发症。方法回顾性分析经手术治疗的58例甲状腺疾病住院病例临床资料,患者接受的手术方式有甲状腺单侧叶＋峡部切除术、甲状腺全切术、甲状腺全切＋中央区淋巴结清扫术、甲状腺二（多）次手术、甲状腺癌根治术＋颈侧区淋巴结清扫术,回顾总结患者术后并发症情况。结果患者术后甲状旁腺素（PTH）均下降,甲状腺单侧叶＋峡部切除术时,其下降程度最小;术后钙均下降,甲状腺二二／多次手术或甲状腺癌根治术＋颈侧区淋巴结清扫术后钙下降值最小;相比甲状腺单侧叶＋峡部切除术的患者,甲状腺全切术、甲状腺全切＋中央区淋巴结清扫术后,患者更易出现手术并发症。结论由于不同疾病不同手术方式并发症的发生率不同,在与患者进行术前沟通时要有针对性,同时在手术中注意保护甲状旁腺和喉返神经,提高手术技巧。     

腰椎间盘突出症术后复发的再手术治疗

目的探讨腰椎间盘突出症术后复发的再手术方法及预防措施。方法对28例腰椎间盘突出症术后复发再手术治疗患者的临床资料进行回顾性分析。结果 28例患者再手术治疗效果满意,其中优16例（57.1%）,良9例（32.1%）,可2例（7.2%）,差1例（3.6%）,优良率为89.2%。结论术前明确诊断、术中准确定位、手术方法选择适当和手术操作过程仔细,既是防止初次手术后复发的关键措施,也是再次实施手术成功的保证。     

经胸乳径路腔镜甲状腺手术与传统甲状腺手术治疗单侧甲状腺良性病变的对比研究

目的比较单侧甲状腺良性病变经胸乳径路腔镜甲状腺手术与传统甲状腺手术的差别,探讨经胸乳径路腔镜甲状腺手术的实用性及优越性。方法回顾性分析了2010年1月～2011年6月收治的单侧甲状腺良性病变患者的资料共50例,其中21例行经胸乳径路腔镜甲状腺手术,设为治疗组;另29例,行传统开放性手术,为对照组。比较两组手术时间、术中出血量、住院时间、术后并发症发生率、术后1年复发率及美容效果。结果两组患者手术均获成功。手术时间治疗组（48.34±13.52）min,显著长于对照组（36.31±12.15）min;术中出血量治疗组为（10.35±5.83）ml,显著低于对照组（26.23±8.21）ml;术后并发症发生率治疗组9.52%,对照组10.34%;术后住院时间治疗组为（3.45±0.51）d,显著低于对照组（4.24±1.06）d。术后1年随访治疗组及对照组均无复发病例。术后1年治疗组患者均对切口瘢痕满意,对照组有15例患者对切口瘢痕不满意。结论单侧甲状腺良性病变行经胸乳径路腔镜甲状腺手术安全可行,相对传统手术在切口美容方面更具优越性。     

边远少数民族地区脊柱结核手术治疗复发原因分析

目的 探讨边远少数民族地区脊柱结核手术治疗复发原因,总结手术治疗经验。方法 收集手术治疗脊柱结核111例,对13例术后复发患者进行归类分析。结果 手术时机掌握不当4例(3.6％);手术清除病灶不彻底3例(2.7％);术后切口处理欠妥3例(2.7%);术后抗结核治疗不规范11例(9.9%);忽视其它部位结核12例(10.81％);与生活环境有关。结论 脊柱结核手术应注意手术时机选择,彻底清除病灶,妥善处理术后切口,坚持规范抗结核治疗,进行综合防治。     

Miccoli手术治疗甲状腺肿物疗效观察

目的观察小切口机械悬吊腔镜辅助下手术(Miccoli手术)治疗甲状腺肿瘤的疗效。方法总结25例Miccoli手术的手术经验,并观察微创及美容效果。结果 24例完成Miccoli手术,均达到开放式手术切除范围,术后无并发症发生,美容和术后恢复优于开放式手术。结论 Miccoli手术治疗甲状腺单发良性肿物安全可靠,并发症少,术后疼痛轻,渗血少,恢复快,美容效果佳。     

腔镜下甲状腺腺瘤切除术23例报告

目的:探讨腔镜下甲状腺腺瘤切除术的可行性及价值。方法:对23例甲状腺腺瘤患者行胸前区入路腔镜下甲状腺腺瘤切除术治疗。结果:23例均完成手术,单侧腺瘤切除术19例,双侧腺瘤切除术4例,平均手术时间99(35~145)min,术后平均住院时间为4.5(3~6)d。随访2月~2年,平均1年,未见复发,无手术并发症,颈部无疤痕,治疗和美容效果满意。结论:腔镜下甲状腺瘤切除术治疗甲状腺腺瘤可取得微创和美容的满意效果。     

手术治疗多发性结节性甲状腺肿60例临床体会

目的：探讨手术治疗多发性结节性甲状腺肿60例临床疗效。方法：采用回顾性分析的方法,分析我院收治的60例多发性结节性甲状腺肿患者的临床资料。结果：所有患者手术均顺利完成,均未发生伤口感染、出血,术后无声嘶及呼吸困难等,未出现喉返神经受损及喉头水肿等并发症发生,所有患者伤口一期愈合后出院。随访6—24个月,随访率100％,术后复发7例,其中患侧甲状腺腺叶切除术5例,腺体次全切除术2例,经二次手术切除甲状腺结节及颈部淋巴结,术后恢复良好。结论：采取不同术式对多发性结节性甲状腺肿治疗疗效明显。     

手术治疗结节性甲状腺肿30例体会

目的：探讨结节性甲状腺肿的临床特点、手术方式及愈后。方法：回顾性分析我院自2006~2009年收治的结节性甲状腺肿30例,分析其临床特点、手术方式及愈后。结果：术后有1例2年内复发,1例出现甲状腺功能低下,1例切口血肿。结论：结节性甲状腺肿的手术既要切尽病变的腺体,又要保留足够的正常腺体。术中仔细操作,术后辅以甲状腺素治疗。     

有占位效应的重型颅脑损伤术后再次手术去骨瓣减压41例分析

目的总结重型颅脑损伤患者因占位性损伤术后再次手术去骨瓣减压的治疗经验。方法回顾性调查2008年1月～2014年10月在四川大学华西医院住院的重型颅脑损伤患者病历,筛查第一次手术清除脑挫裂伤或硬膜下血肿等占位性损伤术后保留骨瓣但再次手术去骨瓣减压的患者,分析再次手术去骨瓣减压原因。结果 41例术后再次手术去骨瓣减压,其中术后局部脑水肿和进展性出血34例,术区新发血肿6例,远隔部位血肿1例。结论有占位效应的重型颅脑损伤患者术后有14.4%的患者再次手术去骨瓣减压,对大多数没有术中脑膨出的患者保留骨瓣是安全的,但对于硬膜下血肿伴脑挫裂伤、伤后早期低血压和初始颅内压35mm Hg的患者可能需要去骨瓣减压。     

飞行人员甲状腺疾病的特点、诊治及医学鉴定

目的 总结飞行人员甲状腺疾病的诊治和医学鉴定经验. 方法 收集我院2000年12月-2009年12月间住院飞行人员67例甲状腺疾病资料,将其归为:①无症状的良性甲状腺结节;②慢性淋巴细胞性甲状腺炎;③甲状腺功能异常类疾病(包括甲状腺机能亢进症和甲状腺机能减退症);④甲状腺恶性肿瘤.分析4类疾病的特点及飞行结论 情况. 结果 ①良性甲状腺结节36例(占53.73%),4例手术治疗(腺瘤3例,结节性甲状腺肿1例),除5例因其他原因停飞外,其余31例均飞行合格,定期复查;②慢性淋巴细胞性甲状腺炎5例(占7.46%),甲状腺功能正常,均飞行合格,定期复查;③甲状腺功能异常类疾病20例(占29.85%,甲状腺机能亢进18例,甲状腺机能减退2例),均行药物治疗,6例飞行合格,3例暂时飞行不合格,11例停飞;④甲状腺恶性肿瘤6例(占8.96%,4例为乳头状癌,2例为滤泡状癌),1例飞行合格,5例停飞.经统计学分析,甲状腺功能异常类疾病和甲状腺恶性肿瘤的停飞率均高于良性甲状腺结节和慢性淋巴细胞性甲状腺炎,且差异有统计学意义(P<0.01或P<0.05). 结论 飞行人员甲状腺疾病以无症状的良性结节常见,要重视功能异常类疾病和恶性肿瘤的早期诊断和治疗. Abstract： Objective To summarize the experiences of diagnosis,treatment and medical evaluation of thyroid disease in flying personnel. Methods Sixty-seven cases of thyroid diseases,that were hospitalized from December 2000 to December 2009,were collected and analyzed.They were concluded such categories as:①asymptomatic benign thyroid nodules;②Hashimoto's disease;③diseases of abnormal thyroid functions (including hyperthyroidism and hypothyroidism);and ④thyroid cancer.Their characteristics and the relationship between different categories were analyzed correspondingly to the evaluations for flying. Results ①Among 36 cases of diagnosed asymptomatic benign thyroid nodules (53.73%),4 (3 were adenoma and 1 was nodular goiter) were surgically treated.31 Cases were evaluated as qualified for flying but should be with regular medical check-up while the other 5 were permanently grounded.②There were 5 cases of Hashimoto's disease with normal thyroid functions (7.46%).They were qualified for flying but should be with regular medical check-up.③Thyroid dysfunction took 20 cases (29.85%),among which 18 were hyperthyroidism and 2 were hypothyroidism.Drug treatment was applied.Six cases were finally qualified for flying while the other 3 and 11 were respectively assessed as temporary and permanent grounding.④Six cases were thyroid cancer (8.96%),included 4 papillary carcinoma cases and 2 follicular thyroid carcinoma cases.Only 1 case was finally qualified for flying while the others were permanently grounded.Statistical analysis showed that thyroid dysfunction diseases and thyroid cancer caused significant higher disqualification rate than benign thyroid nodules and Hashimoto's diseases (P<0.01 or P<0.05). Conclusions Benign thyroid nodules are the common thyroid diseases in flying personnel.But the diagnosis of thyroid dysfunction diseases and thyroid malignant tumors should be cared in order to win the chance of treatment and further to reduce the rate of flying disqualification.     

飞行人员甲状腺功能异常的诊治及医学鉴定

目的 总结甲状腺功能异常飞行人员的临床资料,为规范相关疾病的诊治与鉴定提供依据. 方法 回顾性分析2000年12月至2014年9月间在空军总医院住院的42例甲状腺功能异常的飞行人员病例资料,包括甲状腺功能亢进症和甲状腺功能减退症,总结其疾病特点、诊治过程、治疗效果、医学鉴定结论及随访情况. 结果 ①甲状腺功能亢进症30例（71.43％）,其中26例（86.67％）应用抗甲状腺药物治疗后,医学鉴定结论为飞行合格7例、暂时飞行不合格4例、飞行不合格15例,停飞率57.69％（15/26）.4例（13.33％）应用放射性131I治疗后3例出现甲状腺功能减退;医学鉴定结论为飞行合格2例、暂时飞行不合格2例.②甲状腺功能减退症12例（28.57％）,应用药物替代治疗后,医学鉴定结论为飞行合格9例、飞行不合格3例;3例停飞者中2例为合并心房颤动.结论 飞行人员甲状腺功能亢进症单病种飞行合格率低于甲状腺功能减退症.需要进一步优化飞行人员甲状腺功能亢进症的治疗路径,完善甲状腺功能异常飞行人员的医学鉴定,既最大限度地保存飞行力量又保证飞行安全.     

Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience

The clinical and histopathological records of 149 consecutive patients with papillary thyroid microcarcinoma (PTMC), homogeneously studied and operated on by the same surgeon in the period 1990 to 2001, were reviewed. After a mean 6.5-year follow-up, three cases of loco-regional recurrence (2%) were observed. These three patients had all undergone partial thyroidectomy only and tumour relapse occurred in the residual thyroid tissue. No recurrence was observed in patients treated by total thyroidectomy and I. At variance with other reported series, no lymph node recurrence was observed in our series, in particular in the group of 23 patients with evidence of nodal metastases at initial diagnosis (three of whom were revealed by I scan after surgery). Therefore, a preventive effect of I treatment in our patient population can be hypothesized. However, prolonged follow-up will be necessary to clarify this. Due to the inability of current imaging modalities to select pre-operatively PTMC patients at risk for recurrence (presence of thyroid capsular invasion, multifocality and microscopic lymph node metastases), it appears reasonable to offer the patient total thyroidectomy when a pre-operative diagnosis of PTMC is reached. Moreover, the policy of our thyroid cancer centre is that, in these patients, post-surgical I scan should be obtained in order to detect unknown metastatic deposits, and I treatment should also be considered in patients with poor clinical and histopathological prognostic factors. In contrast, in patients operated on for benign thyroid disease and with delayed diagnosis of PTMC at definitive histopathological examination, re-operation might be avoided in the presence of unifocal disease without thyroid capsular invasion and with ultrasound-'normal' residual thyroid tissue. Close clinical and ultrasound follow-up is recommended, especially in patients who have undergone conservative surgery only.     

食盐碘化对手术患者甲状腺疾病谱的影响

目的 探讨普遍食盐碘化(universal salt iodization,USI)对住院手术患者甲状腺疾病谱的影响.方法 以本院1987-2008年非缺碘地区住院患者的手术病理报告为依据,分析各种病理类型甲状腺疾病的构成比,并对USI前后的甲状腺良、恶性病变发病趋势进行分析.结果 甲状腺癌和结节性甲状腺肿的构成比USI后比USI前明显增加,差异有统计学意义(P<0.01),甲状腺腺瘤的构成比显著下降,差异有统计学意义(P<0.01).结论 非缺碘地区USI实施后,甲状腺病理的组织类型发生显著变化,提示食盐碘化可能是导致甲状腺癌和结节性甲状腺肿增加的重要因素.     

超声误诊58例临床分析

目的：探讨甲状腺结节超声误诊原因,旨在进一步提高超声影像学对甲状腺结节的诊断水平。方法：对2006～2011年间手术治疗的58例甲状腺结节患者超声及病理诊断进行回顾性分析。结果：超声诊断正确14例,误诊33例,漏诊11例。33例误诊病例中恶性误诊为良性者4例,良性误诊为恶性者1例;结节性甲状腺肿误诊为腺瘤3例,结节性甲状腺肿囊性变误诊为腺瘤囊性变25例;11例漏诊病例中,8例结节性甲状腺肿合并腺瘤,其中6例漏诊结节性甲状腺肿,2例漏诊腺瘤;2例腺瘤合并慢性淋巴细胞性甲状腺炎,1例结节性甲状腺肿合并慢性淋巴细胞性甲状腺炎,均漏诊了慢性淋巴细胞性甲状腺炎。结论：对甲状腺结节声像图的多样性,多源性结节共存,良恶性特征交叉重叠认识不足,对甲状腺腺瘤,结节性甲状腺肿,甲状腺癌等的声像图特点掌握不够是误诊的主要原因。     

甲状腺彩色超声检查在飞行员健康体检中的临床价值

目的 调查飞行员甲状腺彩色超声检查结果及鉴定情况,为航空卫生保障提供依据.方法 回顾分析在解放军第四五六医院因健康体检行甲状腺彩色超声检查的629名飞行员的超声检查结果、病理诊断以及医学鉴定情况,并进行统计学分析. 结果 ①629名飞行员中,检出甲状腺疾病139例,阳性率22.10％.②随年龄增长,飞行员甲状腺疾病发病率逐步增高（x2=35.564,P＜0.01）.③甲状腺疾病与飞行员所飞机种无关.④139例患甲状腺疾病的飞行员中飞行合格124例,其中桥本甲状腺炎6例,急性/亚急性甲状腺炎4例;暂时飞行不合格13例,其中原发性甲状腺功能亢进2例,桥本甲状腺炎合并甲状腺功能亢进3例,甲状腺腺瘤术后5例;飞行不合格（停飞）2例,均为甲状腺癌. 结论 结节性甲状腺肿在飞行人员中较常见,对飞行安全无明显影响.甲状腺癌及继发性甲状腺功能亢进患病率有增加趋势,且对飞行安全有着直接或间接影响,应加强预防和早期治疗.甲状腺彩色超声检查对甲状腺疾病的早发现、早诊断、早治疗具有重要意义.     

直肠癌Miles手术后局部复发原因及治疗

目的探讨直肠癌Miles术后局部复发的原因及防治。方法1986年1月-2006年12月共行直肠癌Miles手术218例．对其中术后局部复发35例的临床情况进行回顾性分析。结果局部复发35例中男26例，平均年龄比首次手术组低5岁，DukesC期25例，组织学高度恶性19例，22例肿瘤距肛门3-6cm。复发再手术14例，5年生存率为27．2％（4／14），中位生存期25．4个月（5—144个月）；单纯放化疗21例，中位生存期11．7个月（3—29个月），未手术者均在3年内死亡。结论术后局部复发与年龄、性别、病期、病理类型、肿瘤部位及根治是否彻底密切相关。预防复发宜做好首次手术。对复发病例力争早发现，并予再次手术为主的综合治疗，以延长生存期。     

风心瓣膜替换术后远期三尖瓣关闭不全的原因分析及治疗对策

目的探讨左心瓣膜置换术后远期三尖瓣膜关闭不全(TR)的发生原因及治疗方法。方法6例左心瓣膜置换术后中、重度TR病人,3例行再手术治疗,3例非手术治疗。手术治疗均为Devega成形术。结果手术治疗后的3例恢复良好,随访1~7年,心功能进步为Ⅰ~Ⅱ级。非手术治疗的3例,死亡2例,1例心功能Ⅲ~Ⅳ级。结论第1次手术对TR处理的方法技巧、对轻度TR处理与否的认识问题及对术后心功能的支持等相关措施,与左心瓣膜替换术后远期三尖瓣关闭不全呈明显的相关。对术后出现的中、重度TR应积极行再手术治疗,可取得良好效果。     

CT findings in chondroradionecrosis of the larynx.

PURPOSEOur goal was to describe the CT findings before and after radiation therapy in a series of patients with laryngeal chondroradionecrosis.METHODSThe CT studies obtained before and after radiation therapy in nine patients with the diagnosis of laryngeal chondroradionecrosis were reviewed retrospectively.RESULTSCT scans revealed abnormalities in all patients. A variable degree of laryngeal soft-tissue swelling was seen in eight of the patients. In four patients, cartilaginous abnormalities were visible initially, and appeared in three of four other patients who had further follow-up CT studies. Six patients had involvement of the thyroid cartilage; collapse of the thyroid cartilage was seen in two cases and gas bubbles were visible adjacent to the thyroid cartilage in three cases. Four patients with involvement of the thyroid cartilage eventually underwent total laryngectomy, and one died suddenly in severe respiratory distress. In all three patients with arytenoidal involvement, anterior dislocation of this cartilage was seen; in two of these patients, the adjacent part of the cricoid cartilage showed some sclerosis. Two patients with arytenoidal necrosis (both with cricoidal sclerosis) kept a functional larynx. In one case, cricoidal sclerosis was seen in association with lysis of the thyroid cartilage.CONCLUSIONThe CT appearance of laryngeal chondroradionecrosis is nonspecific, but the diagnosis can be strongly suggested in cases of sloughing of the arytenoid cartilage, fragmentation and collapse of the thyroid cartilage, and/or in the presence of gas bubbles around the cartilage.