喉癌喉部分切除术的术后分析

目的：分析喉癌喉部分切除术后复发的原因和对部分切除术的回顾分析。方法：用免疫组化的方法分析部分喉切除术肿瘤切缘组织PCNA表达和9例肿瘤复发的关系及7例喉切除术后治疗效果的回顾分析。结果：在77例部分喉切除病例中,13例在术后2周拔管,11例3个月拔管,41例1个月拔管,1例6个月拔管,11例未能拔管。3年、5年生存率分别为94％、81％。共9例复发,其中3例做了全喉切除术。结论：如适应症掌握恰当,肿瘤切除足够,部分喉切除治疗喉癌是安全有效的。肿瘤切除保留组织中PCNA阳性可为防止肿瘤复发提供较敏感依据。     

全喉切除术后食管语康复实践

目的总结喉全切除术食管发声训练和效果。方法对我院自1998年6月～2003年6月的59例喉癌、下咽癌全喉切除术后患者,进行食管发声康复训练。结果53例(89.8%)获得不同程度的发声功能,46例无喉者的言语水平接近正常喉言语水平,他们的最大发音时程较长、听距较远,言语可懂度高,较流利;7例发音效果差,但言语可懂度仍高;不能发声者仅6例。结论与其它发声重建相比,食管发声能很快学会发基本音,并具有发声成功率高、发声质量良好等优点。     

喉全切除术后二期发音功能重建术的临床应用

目的 探讨喉全切除术后失声病人重新恢复喉功能的手术法。方法 对36例病人行喉二期发音功能重建术。喉全切除术后时间为2－43个月,平均15个月,采用颈部肌皮瓣连结咽和气管,同时用皮瓣制做会厌,达到能发音,呼吸,吞咽保护功能的目的。结果 全部患者能发,用于指堵管可以口头交谈,1例已拔除气管套管,3例可完全堵管,并发症为误吸较重3例,其中1例并发严重肺内感染后死亡,2例再次封闭喉口失音。术后气管造口复发癌2例。结论 喉全切除术后二期发音重建术能恢复喉发音功能。     

甲状腺全切术喉返神经解剖方式选择对甲状旁腺功能影响的临床研究

目的：通过对比甲状腺全切术中不同喉返神经(RLN)解剖方式对术后甲状旁腺功能的影响,寻求甲状腺全切术最佳的RLN解剖方式,指导临床实践,在RLN解剖安全的前提下减低全甲状腺术后甲状旁腺功能低下的发生率。方法选择已确诊甲状腺癌需行甲状腺全切除手术的120例患者随机分成三组(a、b、c),各40例,分别完成全甲状腺切除术基础上三组不同喉返神经解剖方式(A甲状腺下动脉解剖法、B气管食管沟解剖法、C环甲关节下方解剖法)各40例的手术。观察比较三组患者术后甲状旁腺功能低下的发生率。同时观察比较三组患者术后喉返神经损伤的发生率。结果 c组患者术后甲状旁腺功能低下的发生率明显低于a、b两组。结论甲状腺全切除术时喉返神经解剖方式应选择经环甲关节下方解剖方式,有利于保护甲状旁腺功能,可明显减少甲状腺全切除术后甲状旁腺功能低下的发生率。     

甲状腺手术中对喉返神经和喉上神经保护的临床研究

目的 探讨甲状腺手术中喉返神经(RLN)、喉上神经(SLN)的保护方法,以避免或减少术后永久性神经损伤的发生率。方法 对东南大学医学院附属南京同仁医院耳鼻咽喉头颈外科,2013年6月—2014年11月行甲状腺精细化操作手术治疗141例患者的临床资料进行回顾性分析。其中男37例、女104例,年龄9~78岁。行甲状腺全切54例,甲状腺腺叶切除58例,甲状腺腺叶切除+对侧部分切除29例;其中二次手术者10例,行Ⅵ区清扫者18例。术中RLN显露者121例,未显露者20例。结果 本组141例均顺利完成手术。术后并发RLN暂时性损伤5侧,占2.56%(5/195),给予激素、神经营养药物治疗,并配合发音训练,3个月内神经功能均恢复正常;其中RLN显露组占2.5%(3/121),未显露组占5%(1/20),组间比较差异无统计学意义(χ²=0.396, P＞0.05)。无一例并发RLN永久性损伤和SLN损伤。结论 熟悉RLN、SLN与甲状腺的正常解剖与变异情况,应用被膜解剖技术精细操作,术后可以避免神经的永久性损伤。一旦发生神经损伤,及时给予对症处理,提高患者的生活质量。     

探讨全子宫切除术后的护理

目的：分析全子宫切除术后的临床护理措施。方法在手术完成后为患者提供基础护理、心理护理、饮食护理及健康指导。结果为42例患者提供精心的护理后,无1例患者产生严重并发症,均康复出院,住院时间在4~10d,平均(5.2±1.7)d。结论在全子宫切除术后进行全面及对应的临床护理干预有助于改善患者的预后状况,在临床中应重视推广使用。     

甲状腺手术中识别喉返神经的解剖标志

目的探讨甲状腺手术中用以识别喉返神经的5种有效的解剖标志,为手术中避免误伤喉返神经提供形态学资料。方法采用经福尔马林防腐固定的50具成人标本(男40例,女10例)共100侧,用解剖学方法观测甲状软骨下角尖、甲状腺下动脉、甲状腺下极、气管食管沟和甲状腺悬韧带等5种解剖标志与喉返神经的毗邻关系。结果甲状软骨下角距喉返神经入喉处(6.3±1.9)mm;甲状腺下动脉与喉返神经的毗邻关系有五种类型;右侧喉返神经有64.6%、左侧100%直行于气管食管沟内,在颈根部右侧喉返神经偏离气管食管沟2.1~10.2mm;喉返神经与甲状腺下动脉交叉处位于甲状腺下极之上者占81.1%;喉返神经行于甲状腺悬韧带后方者占92.0%。结论甲状腺手术识别喉返神经的五种解剖标志中,以甲状软骨下角尖(或环甲关节)和甲状腺悬韧带较可靠,其次为甲状腺下极、甲状腺下动脉和气管食管沟。     

分析甲状腺次全切除术的术中护理

目的探讨甲状腺次全切除术患者的术中护理措施。方法选取2012年2月~2014年2月在我院接受甲状腺次全切除术治疗的50例患者,加强对患者术前术中的心理护理,并要求医护人员在术中认真细致地做好围术期护理,严密观察并记录患者全程病情变化。结果50例患者在术前、术中、术后均受到完善护理,无1例出现手术并发症等不良反应,手术成功。结论术前手术室护理人员对患者心理特点的了解程度,术中护理措施是否得当均影响到手术能否顺利进行。同时,加强术中护理措施,是预防各种护理缺陷的重要环节。     

手术中用以识别喉返神经的几种解剖学标志

在52具(103侧)成人尸体上,对手术中用以识别喉返神经的几种解剖标志进行了观察。作者认为,以甲状软骨下角尖(或环甲关节)、甲状腺悬韧带最可靠;其次为甲状腺下极、甲状腺下动脉和气管食管沟。     

腹腔镜及开腹子宫次全切除术对卵巢功能的影响

将32例行腹腔镜子宫次全切术患者为A组,32例行开腹子宫次全切除术患者为B组。用免疫化学发光法测定术前及术后3个月、6个月两组患者血清中卵泡刺激素(FSH)、黄体生成素(LH)均较术前明显升高;雌二醇(E2)较术前明显降低,且B组变化大,有显著性差异(P均<0.05)。A组术中出血量、肛门排气时间、住院时间及并发症发生率均低于B组(P<0.05)。A组具有较好的手术效果,且对卵巢功能影响小。     

Response of the thyroid gland to experimental partial and total pancreatectomy

The terminal or central part of the pancreas was resected or the whole gland removed in dogs. At different times after the operation the morphological and functional state of the thyroid gland was studied by histological, histochemical, and morphometric methods. The changes discovered indicate that structural and functional transformations of the thyroid gland are determined primarily by the type of operation on the pancreas: Resection of the terminal portions causes temporary and slight changes in the thyroid gland, whereas after total pancreatectomy marked degenerative and atrophic changes develop in the glands, leading to a state of functional exhaustion.Department of Operative Surgery, Stavropol' Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR A. P. Avtsyn.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 86, No. 12, pp. 665–668, December, 1978.     

Correlation between the surface area of synovial membrane and the surface area of articular cartilage in synovial joints of the mouse and human

Background  Articular cartilage is avascular. Evidence suggests that in mature animals synovial fluid is the dominant source of nutrition for articular cartilage. If so, there might be a direct correlation between the surface area of synovial membrane and the surface area of articular cartilage in synovial joints. Methods  The hindlimb joints of young adult Swiss Webster mice were prepared for histology and sagitally sectioned at regular intervals. The surface area of synovial membrane and the surface area and volume of articular cartilage were calculated from serial photomicrographs of knee, ankle, and first metatarsophalangeal (MTP) joints using ImageJ software and Cavalieri’s method. Sagittal E12 slices from numerous synovial joints in a single human cadaver were similarly analysed. Results  There was a strong statistically significant positive linear correlation between the surface area of synovial membrane and articular cartilage in the hindlimb joints of the mouse (r = 0.96, 95% CI 0.90–0.98, P < 0.0001). A similarly strong highly statistically significant corelation was observed between the surface area of synovial membrane and volume of articular cartilage. This relationship was also observed across a wider range of synovial joints in the human (r = 0.83, 95% CI 0.48–0.95, P = 0.0009). All analyses remained highly statistically significant after adjusting the standard errors and consequent P values for the linear models based on multiple observations in the same subject. Conclusions  This study demonstrates for the first time that there is a direct positive linear correlation between the surface area of synovial membrane and the surface area of articular cartilage in synovial joints in the mouse and human. These novel findings support the concept that the nutrition of mature articular cartilage is dependent on synovial fluid and may also explain why some joints communicate with surrounding bursae. Perhaps more consideration should be given to synovial membrane when studying the pathology of articular cartilage.     

Medullary carcinoma of the thyroid presenting as tumours of the pharynx and larynx

Two cases of medullary carcinoma of the thyroid presenting as tumours of the pharynx and larynx are described. One patient had a tonsillar mass that resembled a carotid body tumour clinically, radiologically and microscopically. The other had an arytenoid tumour with multiple cervical lymph node metastases but without intrathyroidal carcinoma. The endocrine nature of the neoplasms was indicated by the presence of stromal amyloid, cellular argyrophilia and secretory granules whilst the demonstration of calcitonin and carcinoembryonic antigen provided evidence that they were medullary carcinomas.     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

Abstract: The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.     

Malignant hemangioendothelioma of the thyroid and factor VIII-related antigen

Summary Thirty-six malignant hemangioendotheliomas of the thyroid were examined immunohistochemically using antibody probes to factor VIII-related antigen in order to reevaluate the histogenesis of this neoplasia. The 36 cases were reclassified according to their light microscopic features without prior knowledge of the immunohistochemical results. Three different tumor types were discerned: Group I: classical hemangioendotheliomas (20 cases); Group II: borderline cases between malignant hemangioendotheliomas and anaplastic carcinomas (14 cases) and Group III: anaplastic carcinomas with hemangio-endotheliomatous features (2 cases). Factor VIII-related antigen could be demonstrated in 12 (60%) tumors of group I, 3 (21%) tumors of group II and in neither tumor of group III. Five control cases with the typical histological picture of anaplastic carcinoma of the thyroid were negative for factor VIII-related antigen. The results of our study suggest that at least part of the tumors termed as malignant hemangioendotheliomas are in fact derived from endothelial cells.This work was supported by grants from the Wilhelm Sander-Stiftung, Neustadt/Donau and the Emil Barell-Stiftung, Basel     

Expression of parathyroid hormone-related peptide (PthrP) and its receptor (PTH1R) during the histogenesis of cartilage and bone in the chicken mandibular process

The purpose of this study was to examine the expression and actions of parathyroid hormone-related protein (PTHrP) when skeletal histogenesis occurs in the chicken mandible. Prior to the appearance of skeletal tissues, PTHrP and PTH1R were co-expressed by cells in the ectoderm, skeletal muscle, peripheral nerve and mesenchyme. Hyaline cartilage was first observed at HH stage 27 when many but not all chondroblasts expressed PTHrP and PTH1R. By stage 34, PTHrP and PTH1R were not detected in chondrocytes but were expressed in the perichondrium. Alkaline phosphatase (AP)-positive preosteoblasts and woven bone appeared at stages 31 and 34, respectively. Preosteoblasts, osteoblasts and osteocytes co-expressed PTHrP and PTH1R. Treatment with chicken PTHrP (1-36) increased cAMP in mesenchyme from stage 26 embryos. Continuous exposure to chicken PTHrP (1-36) for 14 days increased cartilage nodule number and decreased AP while intermittent exposure did not affect cartilage nodule number and increased AP in cultures of stage 26 mesenchymal cells. Adding a neutralizing anti-PTHrP antibody to the cultures reduced cartilage nodule number and did not affect AP. These findings show that PTHrP and PTH1R are co-expressed by extraskeletal and skeletal cells before and during skeletal tissue histogenesis, and that PTHrP may influence skeletal tissue histogenesis by affecting the differentiation of mandibular mesenchymal cells into chondroblasts and osteoblasts.     

Mixed medullary and follicular carcinoma of the thyroid

Summary We report a case of medullary carcinoma of the thyroid which on light microscopy showed not only the well known arrangement of cells in sheets and nests but also unequivocal follicular structures. These follicular structures are present both in the primary tumor and in lymph node metastases. Immunohistochemical investigations revealed that the cells lining the follicles produce thyroglobulin, whereas the remaining tumor tissue is positive for calcitonin and carcinoembrionic antigen. This case represents a medullary carcinoma of the thyroid with an atypical pattern consisting of both thyroglobulin and calcitonin producing cells.Dedicated to Prof. K. Akazaki, Nagoya/Japan, on the occasion of his 80th birthday     

Abnormal intracellular and extracellular distribution of basement membrane material in papillary carcinoma and hyalinizing trabecular tumors of the thyroid: Implication for deregulation of secretory pathways

Papillary carcinoma (PC) and hyalinizing trabecular tumors (HTT) of the thyroid share several morphological features, including the presence of nuclear pseudoinclusions (NPI). One of the distinct characteristics of HTT is its hyalinizing stroma, which contains abundant basement membrane (BM) material. We investigated the distribution of BM material in PC and HTT. Fifteen cases of PC and nine cases of HTT were analyzed immunohistochemically with monoclonal antibodies for type IV collagen and laminin. Three stromal staining patterns were observed: (1) linear staining along the epithelium lining papillae, between trabeculae, and around follicles; (2) focal absence of staining; (3) lumpy or diffuse stromal staining. Although the latter was more commonly seen in HTT, all three patterns were present in both tumor types. More interestingly, we observed two hitherto undescribed intracellular staining patterns in both tumor types: intracytoplasmic dotlike staining and staining of NPI. Electron microscopy was performed in three cases of PC. Dilated cisternae of endoplasmic reticulum containing dense amorphous material resembling BM were observed in the cytoplasm in one case and in the NPI in another. These findings suggest the presence of a common pathway for the abnormal production of BM in both PC and HTT. Two mechanisms that may account for the abnormal intracellular detection of BM materials are proposed: (1) intracellular invagination/phagocytosis of extracellular matrix by the tumor cells; (2) abnormal production or alteration in secretory pathway in tumor cells resulting in intracellular accumulation and intranuclear invagination. The combination of immunohistochemical and electron microscopic findings favors the latter. The similar patterns of BM deposition shared by PC and HTT further support the hypothesis that PC and HTT are related to each other.     

Estimation of number of follicles, volume of colloid and inner follicular surface area in the thyroid gland of rats

Volume is an important variable in assessing the growth and involution of the thyroid gland. The functional unit in the thyroid is the follicle, which consists of thyrocytes surrounding colloid. The size of a follicle depends on the number of cells and the amount of colloid. These are interchangeable and vary according to biological activity. Direct measurements of these variables provide information on structures involved in thyroid hormone synthesis, storage and secretion, and also on changes at the morphological and functional levels. Stereological methods are developed to obtain information on three-dimensional structures from two-dimensional sections and to achieve information on an entire organ by examining a minor part of it. Full-grown male Sprague-Dawley rats were used to develop a set of methods relying on unbiased stereological principles to determine the number of follicles, the total volume of colloid and the inner follicular surface area in the thyroid gland. The total volume of colloid was positively correlated (P < 0.021) with the number of follicles and the inner follicular surface area (P < 0.002) but not to the mean volume of colloid in each follicle. Thus under physiological conditions an increase in the total volume of colloid is associated with an increased number of follicles with a constant size distribution rather than a larger volume of colloid in each follicle. This implies that under physiological conditions there is equilibrium in the size distribution of the volume of colloid in each follicle.