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甲状腺再次手术因原切口处解剖关系不清 ,易发生医源性损伤。本文仅对甲状腺再手术手术入路方式进行探讨。1　临床资料我院 1998～ 2 0 0 0年共行甲状腺再手术 30例。其中男2例 ,女 2 8例。年龄 2 8～ 80岁。首次手术诊断结节性甲状腺肿 2 0例 ,甲状腺机能亢进 (甲亢 ) 4例 ,乳头状甲状腺癌 1例。 8例病人术前Ｘ线片示气管狭窄 ,其中 3例合并呼吸困难。本组病例再手术行甲状腺次全切除术 16例 ,单侧残余甲状腺切除加部分颈前肌群切除 5例 ,单侧全切加同侧颈淋巴结清扫 1例 ,单侧次全切除术 8例。手术入路 :颈阔肌下正中入路 8例 ,双颈阔肌下…     

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甲状腺素在外科中一直用来治疗慢性淋巴细胞性甲状腺炎 ,还作为甲状腺全切术后的替代治疗或甲状腺癌术后抗复发的重要药物。近年来有许多关于甲状腺素在治疗非甲状腺疾病 (ｎｏｎｔｈｙｒｏｉｄａｌｉｌｌｎｅｓｓ ,ＮＴＩ)中作用的报道 ,如治疗心衰、高脂血症等。本文就甲状腺素在外科中一些新的应用作一总结。1　甲状腺素在外科危重病人中的应用　　我们于 1987年发现急性梗阻性化脓性胆管炎病人Ｔ3水平明显低于胆管结石和胆囊结石病人 ,并且随病情改善而恢复正常[1] 。众所周知 ,老年病人行急症手术的并发症及病死率均高 ,而那些存在低Ｔ…     

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Ⅵ区淋巴结清扫术是甲状旁腺损伤的风险因素,掌握术中甲状旁腺保护技术对预防术后甲状旁腺功能低下有重要的临床意义。熟悉甲状旁腺的解剖及血供特点,准确识别甲状旁腺,并通过精细的操作避免损伤甲状旁腺及其血供,有利于保护甲状旁腺及其功能。对上位甲状旁腺强调原位功能性保护,对下位甲状旁腺则以自体移植为主。准确判断保留的甲状旁腺活力,对血运明显异常的甲状旁腺应在病理检查证实后进行自体移植。双侧Ⅵ区淋巴结清扫、再次手术、甲状腺癌伴外侵、桥本病或甲状腺功能亢进并存甲状腺癌是更加值得注意的手术方式和疾病类型。     

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??Techniques and skills of protection for the parathyroid gland during thyroid surgery YIN De-tao, ZHAO Bo. Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University?? Key-Discipline Laboratory Clinical Medicine, Zhengzhou 450052, China
Corresponding author : YIN De-tao, E-mail??detaoyin@zzu.edu.cn
Abstract As the incidence of thyroid cancer increases recently??the number of patients with hypoparathyroidism who get thyroid cancer surgery grows as well.How to prevent hypoparathyroidism seems to have become one of the most vital points for thyroid surgeons. Surgeons should have a strong sense of parathyroid protection, fine anatomy of the membrane, choose the appropriate surgical methods, through the operation of the naked eye identification, exploration, parathyroid development and other techniques to determine its location, rationally use of advanced energy platform to avoid damage to the parathyroid gland. For those parathyroid glands that cannot be retained or mistakenly cut in situ, the risk of permanent parathyroid dysfunction can be minimized by transplantation.     

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??Application value and evaluation of robotic surgical system in robotic thyroidectomy YAN Ji-qi. Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Abstract With advantages of excellent three dimension visualization and increased dexterous manipulation??da Vinci robotic system has been widely used in surgical operation practice??and gradually extended to all surgical subspecialities. Since the first introduce of robotic thyroidectomy in 2007??da Vinci system integrates the advantages of endoscopic and open thyroid surgery. The high system technique assures accuracy and safety of robotic thyroidectomy. Under the clinical accumulation of operation experience??robotic thyroidectomy gradually demonstrates its unique advantages.     

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??Parathyroid reservation in the surgery of thyroid carcinoma WU Yi. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC),Shanghai 200032, China
Abstract Since the incidence of thyroid carcinoma has been elevated, the number of patients received the radical surgery of bilateral thyroid carcinoma has also increased. Hypoparathyroidism is a major complication after total thyroidectomy due to the anatomy and vascularation. The superior parathyroid should be reserved in situ, as for the inferior parathyroid, in situ vascularized prarathyroid reservation combined with parathyroid autotransplantation should be applied. Effort should be made to ensure the reservation of each parathyroid as long as the radical dissection of original tumor has been done.     

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全甲状腺切除术在临床的应用日益增多。如何保护甲状旁腺、减少和避免发生严重甲状旁腺损伤已成为学界关注的重要问题。手术分级管理制度、专科医生培养、手术者高度负责的态度、手术中操作精细和仔细检查辨认、即刻自体甲状旁腺移的补救措施等环节构成了完整的预防规程,可使全甲状腺切除术的永久性甲状旁腺功能减退症发生率有效降低。     

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??Managements for the incidental gallbladder carcinoma during or after cholecystectomy YIN Xiao-yu. Department of Pancreatobiliary Surgery??the First Affiliated Hospital??Sun Yat-Sen University??Guangzhou 510080??China
Abstract The incidental gallbladder carcinoma during or after cholecystectomy is referred as to gallbladder carcinoma confirmed by pathological examinations of the excised gallbladder specimens which is considered as benign gallbladder lesions preoperatively. Its incidence is ranged from 0.25% to 3.00%??and it is more common in the area with high prevalence of gallbladder carcinoma. Gallbladder carcinoma progresses rapidly and has a poor prognosis. Optimal management for the incidental gallbladder carcinoma during or after cholecystectomy plays pivotal roles in determining patients’ long-term prognosis. Currently??there still lack of the generally-accepted standard managements for the incidental gallbladder carcinoma during or after cholecystectomy??and exist controversies in some aspects.     

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??Clinical significance of calcification in Hashimoto's thyroiditis with thyroid cancer LONG Guan-bao, ZHANG Chun-xia, ZHENG Jian-wei, et al. Department of Biliary-pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030,China
Correspondence author: SHEN Ming, E-mail:shen_ming75@yahoo.com.cn
Abstract Objective To investigate the clinical significance of calcification in Hashimoto's thyroiditis with thyroid cancer. Methods The clinical data of 184 cases of Hashimoto's thyroiditis asscciated with thyroid cancer treated between January 2001 and December 2011 in Department of Biliary-pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (excluding cases with a history of thyroid surgery) were analyzed retrospectively. Results Hashimoto's thyroiditis associated with thyroid cancer was in 43 cases??23.4%??43/184??, with calcification in 26 cases. Among 141 cases of Hashimoto's thyroiditis and Hashimoto's thyroiditis associated with benign thyroid diseases, 13 cases had calcifications. The ratio of calcification in Hashimoto's thyroiditis associated with thyroid cancerthe was higher than that in Hashimoto's thyroiditis associated with benign thyroid diseases (P<0.05). There were 22 cases of microcalcifications in 26 cases of malignant calcification while coarse calcifications were 3 cases. The specificity of microcalcifications ratio in Hashimoto's thyroiditis with thyroid cancer was 84.6%??22/26??.The diagnosis rate of Hashimoto's thyroiditis associated with thyroid cancer performed FNAC was 67.6%(25/37). Conclusion Microcalcification has the high specificity for the diagnosis of Hashimoto's thyroiditis associated with thyroid cancer. Prompted Hashimoto's thyroiditis patients with microcalcifications on ultrasonography should be positive surgical exploration combined with intraoperative rapid pathological examination, which can improve the rate of early diagnosis of Hashimoto's thyroiditis associated with thyroid cancer effectively.     

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目的　探讨手术中、手术后短时间高浓度氧疗对腹部污染手术切口感染的影响。方法　 2 0 0 1年 1月至 2 0 0 3年 4月行腹部污染手术 196例 ,随机分组。手术开始至术后 2h内观察组 (98例 )用防漏面罩供氧 (FiO26 0 % ) ,对照组 (98例 )用鼻导管供氧 (FiO2 2 8% )。除阑尾手术外术后 2h抽股动脉血测定血气分析 ,均测定末梢动脉血氧饱和度 ,记录有无氧中毒表现。观察切口至术后 15d ,切口丙级愈合为切口感染。结果　两组无氧中毒表现。术后 2h动脉血气分析 ,观察组PaO2 为 (16 5 3± 38 6 )mmHg ,对照组为 (118 1± 2 9 4 )mmHg ,两组比较 P<0 0 0 1。术后末梢动脉血氧饱和度两组均正常。观察组切口感染 5例 (5 1% ) ,对照组 14例 (14 3% ) ,两组比较P <0 0 5。结论　手术中、手术后短时间高浓度氧疗可减少腹部污染手术切口感染。     

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??Analysis of the risk factors of incidental parathyroidectomy during thyroid cancer surgery WANG Xing,ZHU Yi-ming,HUANG Hui, et al. Department of Head and Neck Surgery, Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing100021,China
Corresponding author: WANG Xiao-lei??E-mail??wangxlcams@126.com
Abstract Objective To analyze the risk factors of parathyroidectomy during thyroid cancer surgery.Methods The clinical data of 1047 patients with newly discovered papillary thyroid carcinoma who underwent surgery in Department of Head and Neck Surgery, Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from October 1, 2014 to October 1, 2015 were analyzed retrospectively. All patients were divided into two groups according to postoperative pathology whether parathyroid gland exists and the various factors were compared between two groups. Additionally??parathyroidectomy rate among the different locations were also compared according to whether to use the nano-carbon. Results The overall parathyroidectomy rate was 18.9%. Univariate analysis showed that patients with the features of males??invasion of the capsule??neck lymph node dissection had a higher rate of incidental parathyroidectomy??and the difference was significant statistically. Multivariate analysis showed that males and invasion of the capsule were independent risk factors for incidental parathyroidectomy. In the comparison of incidental parathyroidectomy locations??it demonstrated that nano-carbon had protective effect on the parathyroid glands located in intrathyroid or juxtathyroid and central location??but the difference was statistically significant only in the former. Conclusion Males??invasion of the capsule??neck lymph node dissection are the risk factors of incidental parathyroidectomy. The application of nano-carbon has a better protective effect on parathyroid glands which are located in intrathyroid or juxtathyroid.     

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??Some questions of diagnosis and treatment in gallbladder carcinoma QUAN Zhi-wei. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Abstract Gallbladder carcinoma has been considered the malignancy with dismal prognosis due to its propensity for early dissemination and delayed diagnosis at an advanced tumor stage, and the improved survival could be obtained by the early and precise diagnosis. Surgical radical resection with tumor-free margins provides the only method for long-term survival. Scientific tumor staging system could not only indicate the tumor stage but also do favor for the choice of operation and prediction of prognosis. Unnecessary laparotomy could be avoided by routinely staging laparoscopy. More attention should be paid to the radical resection of incidental gallbladder carcinoma and comprehensive treatment of advanced gallbladder carcinoma. With the development of clinical and basic research of gallbladder carcinoma, comprehensive and standardized treatment, as well as the establishment of professional team on biliary tract carcinoma surgery should also be emphasized.     

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??Diagnosis in thyroid nodules with coexistent chronic autoimmune Hashimoto thyroiditis by shear wave elastography LIANG Jin-yu*??LIU Bao-xian??WANG Wei??et al. *Department of Medical Ultrasonics??Institute of Diagnostic and Interventional Ultrasound??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080,China
Corresponding author: WANG Wei??E-mail??wangw73@mail.sysu.edu.cn
Abstract Objective To assess the diagnostic performance of shear wave elastography (SWE) in the differentiation of thyroid nodules with coexistent Hashimoto thyroiditis??HT??. Methods From January 2013 to June 2014??conventional ultrasound (US) and SWE were performed on 297 suspicious thyroid nodules of 260 patients with histological confirmation. 73 patients with 83 nodules were included in the HT group. Results SWE value in the maglignant nodule was significant higher than that in the benign one and surrounding parenchyma (64.4±42.8??kPa vs??26.8±15.3??kPa vs??17.7±5.3??kPa, P<0.05). SWE value in HT group of malignant module was significantly higher than that of benign one and surrounding parenchyma. In the benign and malignant nodules??SWE value between HT and non-HT groups showed no significant differences (P>0.05). SWE value of surrounding parenchyma in HT group was higher than that in non-HT group and had positive correlation with TPO-Ab(r=0.307, P<0.05). Optimal value of SWE to diagnose malignancy was 39.1kPa with sensitivity, specificity and accuracy 68.9%,91.7% and 82.9%, respectively. Conclusions 39.0 kPa of SWE value showed good diagnostic performance in the differentiation of malignant and benign thyroid nodules with coexistent HT.     

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??Clinical effects of laparoscopic surgery by medial-cephalo to lateral approach in the treatment of rectal cancer LUO Yang, YU Min-hao, CHEN Jian-jun, et al. Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Corresponding author??ZHONG Ming, E-mail??drzhongming1966@163.com
Abstract Objective To evaluate the clinical effects of medial-cephalo to lateral approach for laparoscopic radical resection of rectal cancer. Methods The clinical data of 132 rectal cancer patients??undergoing laparoscopic resection of rectal cancer in Renji Hospital, Shanghai Jiao Tong University School of Medicine from October 2016 to June 2017 were analyzed retrospectively??including 42 cases with medial-cephalo to lateral ??MCL?? group??35 cases with cephalo-medial to lateral ??CML?? group??and 55 cases traditional medial-lateral ??ML?? group. The clinical conditions during operation situations??postoperative situations and follow-up situations were compared among three groups. Results The operative time was the highest in CML group??146.90±5.92??min??followed by the MCL group??127.50±4.18??min and the ML group??122.90±3.97??min??P=0.002????In terms of the time of No.253 lymph node dissected??the CML group was lowest??11.91±0.38??min??followed by the MCL group??12.24±0.29??min and the ML group??15.76±0.44??min??P??0.001????Compared the number of No.253 lymph node dissected in the three group. The CML group was the best??2.929±0.190????followed by MCL group??2.686±0.220??and CM group??1.709±0.090????P??0.01??. While in other cases??such as volume of intraoperative blood loss??number of lymph node dissected and postoperative complications were no significant difference in the three group.Tumor recurrence??metastasis??and tumor-free death occurred during follow-up in all patients. What’s more??all patients had no tumor recurrence??no distant metastasis and no tumor-related death during follow-up. Conclusion The medial-cephalo to lateral approach is safe and feasible for laparoscopic radical resection of rectal cancer??and an advantage of No.253 lymph node dissection??which cannot extend the operation time??