无充气耳后发际入路完全腔镜下甲状腺癌根治术效果初探

背景与目的：目前国内经耳后发际入路完全腔镜下甲状腺癌根治术鲜有报道。探讨该术式可行性及安全性。方法：2018年2月—2019年1月选取无充气耳后入路完全腔镜下和颈前切口甲状腺癌根治术各12例,比较两组临床特征、手术情况、术后并发症及美容满意程度。结果：腔镜组与开放组年龄、性别、肿瘤大小、住院时间、颈部疼痛、中央区淋巴结清扫数目相比,差异无统计学意义（P>0.05）;腔镜组平均手术时间［（88.1±13.8）min］较开放组［（60.4±9.4）min］更长,引流液总量［（134.2±62.0）mL］较开放组［（87.1±26.7）mL］更多（P=0.024）。腔镜组可获得更理想的美容满意度（P<0.01）。结论：无充气耳后发际入路完全腔镜下甲状腺癌根治术安全、可行,美容效果极佳,值得推广。     

完全腔镜下甲状腺癌根治术对甲状腺癌的疗效分析

目的 分析完全腔镜下甲状腺癌根治术对甲状腺癌的疗效。方法 选取甲状腺癌患者88例,随机分为腔镜组和开放式组,各组44例。开放式组予以开放式甲状腺切除术,腔镜组予以完全腔镜下甲状腺癌根治术。对比两组围术期情况、认知功能、疼痛情况、外周血循环肿瘤细胞、并发症发生率。结果 腔镜组失血量、术后引流量较开放式组少,手术时间较开放式组长,住院时间较开放式组短(P<0.05);术后24、48 h,腔镜组认知功能评分均较开放式组高(P<0.05);术后24、48、72 h,腔镜组疼痛评分均较开放式组低(P<0.05);术后24、48 h,腔镜组外周血循环肿瘤细胞均较开放式组低(P<0.05);腔镜组并发症发生率[2.27%(1/44)]较开放式组[18.18%(8/44)]低(P<0.05)。结论 完全腔镜下甲状腺癌根治术治疗甲状腺癌患者,可有效改善围术期情况,加快术后康复进程,还可减轻疼痛和对认知功能的影响,降低肿瘤细胞残留率,减少并发症发生风险。     

体重指数对经腋窝入路免充气全腔镜甲状腺癌根治手术的影响

<正>甲状腺癌较为高发,女性发病率明显高于男性,目前指南推荐首选治疗手段仍然是手术切除^[1]。相较于传统颈前入路手术会在颈部留下永久性的瘢痕,经腋窝入路甲状腺手术因在颈部不留瘢痕而深受欢迎^[2]。本文通过回顾266例因甲状腺癌行经腋窝入路免充气全腔镜甲状腺癌根治手术的患者临床资料,初步研究超重和肥胖对该术式的影响,给临床诊治提供参考。1 资料与方法1.1 一般资料     

两种入路无充气腔镜甲状腺手术与颈前入路甲状腺手术对比分析

摘 要：［目的］ 探讨无充气腋窝入路及耳后入路腔镜甲状腺癌根治术的治疗效果及美容效果。［方法］ 150例甲状腺恶性肿瘤患者自主选择行无充气腋窝入路手术（60例）、耳后入路手术（30例）和颈前入路手术（60例）,比较3组患者的并发症、围手术期相关指标及美容满意度差异。［结果］ 腋窝组手术总时间为（79.4±20.3）min,耳后组为（81.3±10.9）min,均较颈前组[（58.7±8.5）min]时间长（P<0.01）;腋窝组引流液总量为（110.0±30.6）ml,耳后组为（120.0±43.8）ml,均较颈前组的[（76.5±22.5）ml]引流液增多（P<0.01）;3组间中央区淋巴结清扫数、中央区淋巴结阳性数、术中出血量差异均无统计学意义。腔镜组患者美容满意度更高（P<0.01）,且腋窝入路美容满意度高于耳后入路（P=0.012）。［结论］ 两种入路无充气完全腔镜下甲状腺癌根治术在合适的甲状腺癌患者中可达到与颈前入路相同的治疗效果,且美容效果更好。     

经腋窝入路无充气腔镜甲状腺手术10例临床效果观察

摘 要：［目的］ 探讨经腋窝入路无充气腔镜甲状腺手术治疗甲状腺肿瘤的临床效果。［方法］ 回顾性分析10例甲状腺肿瘤患者,行经腋窝入路无充气腔镜甲状腺手术。观察手术时间、手术出血量、术后总引流量、术后并发症、患者对术后美容效果满意程度等指标。［结果］ 所有患者均顺利完成腔镜下手术并随访,随访时间（6.0±2.5）个月。经腋窝入路无充气腔镜甲状腺手术组的手术时间（178.33±32.46）min,术中出血量（60.00±53.75）ml,术后总引流量（257.30±101.75）ml,术后并发症少、患者对术后美容效果满意程度较高。［结论］ 经腋窝入路无充气腔镜甲状腺手术安全、可行,对颈前功能区保护良好,美容效果较好。     

完全腔镜下甲状腺癌根治术与传统开放手术的临床效果对比分析

摘 要：［目的］ 对完全腔镜下与常规开放手术治疗分化型甲状腺癌的临床效果进行对比分析。［方法］ 回顾性分析进行甲状腺癌根治术的女性患者100例,腔镜组与开放组各50例,对两组患者的年龄、肿瘤大小、淋巴结清扫及转移数目、手术时间、术后24h内引流量、住院天数、术后第1d及第3d疼痛评估、术后并发症及患者满意度等指标间进行比较。［结果］ 所有患者手术均顺利完成,腔镜组年龄及住院天数均小于开放组（P<0.05）;腔镜组术后24h引流量、术后第1d疼痛评估、手术时间及患者满意度均大于开放组（P<0.05）;两组肿瘤大小、淋巴结清扫及转移数目、术后第3d疼痛评估、术后并发症等指标间差异无统计学意义（P>0.05）。术后3个月美容满意度腔镜组优于开放组（P=0.012）。［结论］ 对于分化型甲状腺癌,两种术式治疗效果相近,而腔镜手术具有明显的美容优势,住院时间更短。     

乳腺癌腔镜腋窝淋巴结清扫术Meta分析

摘 要： ［目的］ 探讨腔镜下腋窝淋巴结清扫术在乳腺癌外科治疗中的可行性、有效性及安全性。［方法］ 检索Cochrane、Pubmed、EMbase、中国知网、维普及万方数据库相关文献,时间截止在2017年6月以前,对符合纳入标准的所有文献进行相关的质量评价和荟萃分析。［结果］ 最终纳入12项随机对照试验,共包括1983例患者。腔镜与传统开放性腋窝淋巴结清扫手术相比,前者在术中出血量(SMD=－4.71,95%CI：－6.15~－3.27,P<0.01)、术后腋窝引流量(SMD=－4.26,95%CI：－5.10~－3.42,P<0.01)、住院时间(SMD=－1.24,95%CI：－1.75~－0.74,P<0.01)及术后相关并发症发生率(OR=0.22,95%CI：0.11~0.42,P<0.01)均少于后者,两组方案在手术时间(SMD=－0.47,95%CI：－1.42~0.48,P=0.34)、术中清扫淋巴结数目(SMD=0.10,95%CI：－0.05~0.24,P=0.18)、住院费用(SMD=1.65,95%CI：－1.32~4.63,P=0.28)及术后复发转移发生率(OR=0.75,95%CI：0.33~1.71,P=0.49)差异无统计学意义。［结论］ 在保证不影响患者预后的前提下,腔镜下腋窝淋巴结清扫术可以减轻对患者的创伤,同时可以减少术后并发症的发生,为该微创技术在我国临床领域的进一步开展提供了参考依据。     

经胸-乳入路腔镜甲状腺癌根治术治疗早期甲状腺乳头状癌的疗效及对应激激素、甲状腺球蛋白的影响

目的 研究经胸-乳入路腔镜甲状腺癌根治术(ERT)治疗早期甲状腺乳头状癌(PTC)的疗效及对应激激素、甲状腺球蛋白(Tg)的影响.方法 将82例PTC患者按照随机数字表法分为试验组(n=41)与对照组(n=41),试验组行经胸-乳入路ERT,对照组行常规手术治疗.观察两组患者手术相关指标,术前及术后7天比较两组患者血清甲状腺功能指标[促甲状腺激素(TSH)、三碘甲状腺原氨酸(T3)、甲状腺激素(T4)]、应激激素指标[血清皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素-2(AT-Ⅱ)、超氧化物歧化酶(SOD)]及Tg水平,比较两组患者术后并发症发生情况.结果 试验组患者伤口长度、术后住院时间均明显短于对照组,术中出血量、术后引流量均明显少于对照组,手术时间明显长于对照组,差异均有统计学意义(P﹤0.01).术后7天,两组患者血清TSH、SOD水平均升高,T3、T4、Cor、NE、AT-Ⅱ、Tg水平均降低(P﹤0.05),且试验组患者TSH、SOD水平明显高于对照组,T3、T4、Cor、NE、AT-Ⅱ、Tg水平均明显低于对照组(P﹤0.01).试验组患者并发症总发生率低于对照组,差异有统计学意义(P﹤0.05).结论 经胸-乳入路ERT治疗早期PTC可有效切除病灶,改善患者甲状腺功能,且创伤小,应激反应弱,术后恢复快,并发症发生率低,值得临床推荐.     

腔镜甲状腺癌手术的进展与争议

随着腔镜技术的快速发展,经腔镜甲状腺手术因其颈部无瘢痕、手术切口隐蔽等优势受到欢迎。但腔镜下甲状腺癌手术因其适应证尚不明确、颈侧区淋巴结清扫困难等因素,在能否根治甲状腺癌的问题上仍存在争议。经相关文献的复习,本文将基于腔镜下甲状腺癌手术的最新进展,对腔镜下甲状腺癌的适应证以及现存的争议进行论述、对其存在的风险提出规避对策,并为腔镜下甲状腺癌术将来的走向提供合理化建议。     

乳腺癌腔镜腋窝淋巴结清扫术后患侧肢体功能的评价

目的评价腔镜腋窝淋巴结清扫术对乳腺癌患者患侧上肢功能的影响。方法 2005年10月至2009年10月在我院住院的乳腺癌患者,按腋窝淋巴结处理方式不同分为腔镜腋窝淋巴结清扫组（A组,123例）和常规腋窝淋巴结清扫组（B组,115例）,随访两组患者术后6、12、24及≥36个月以上患侧上肢活动受限、感觉障碍、疼痛、淋巴水肿以及腋窝部肿瘤复发的发病情况。结果腔镜腋窝淋巴结清扫组（A组）患者术后6、12、24及≥36个月以上其肩关节活动受限、感觉障碍、疼痛的发病情况与常规腋窝淋巴结清扫组（B组）比较,差异无显著性（P〉0.05）,但是,患侧上肢淋巴水肿的发生率则分别为13.5%比34.6%,17.6%比36.5%和18.2%比35.0%,差异有显著性（P〈0.05）。7～55个月的随访中两组患者均未发现腋窝部肿瘤复发。结论乳腺癌患者行腔镜腋窝淋巴结清扫术与常规腋淋巴结清扫术比较可降低患侧上肢淋巴水肿的发生率,而在肩关节活动、感觉障碍、疼痛及腋窝部肿瘤复发方面无差异。     

经口腔前庭内镜甲状腺癌切除术治疗甲状腺癌的临床疗效

目的探讨经口腔前庭内镜甲状腺癌切除术对甲状腺癌患者的临床疗效。方法将112例甲状腺癌患者按照治疗方法的不同分为对照组(n=56)和观察组(n=56),对照组患者接受常规甲状腺癌切除术,观察组患者接受经口腔前庭内镜甲状腺癌切除术,观察比较两组患者围手术期情况、临床疗效及术后并发症发生情况。结果对照组患者手术时间短于观察组,术中出血量多于观察组,术后24h疼痛评分高于观察组,开始进食时间、颈部活动时间及住院时间均长于观察组,差异均有统计学意义(P﹤0.05)。观察组患者治疗后的临床总有效率为91.07%(51/56),高于对照组的71.43%(40/56),差异有统计学意义(P﹤0.05)。两组患者术后并发症发生情况比较,差异无统计学意义(P﹥0.05)。结论经口腔前庭内镜甲状腺癌切除术较常规甲状腺癌切除术对患者创伤较小,术后恢复较快,临床疗效较好且安全性较高。     

经胸乳入路腔镜甲状腺手术与传统甲状腺手术的疗效对比

目的:对比经胸乳入路腔镜甲状腺手术与传统甲状腺手术的临床疗效,探讨经胸乳入路腔镜甲状腺手术的可行性和优势。方法:回顾性分析了2011年12月至2014年3月收治的314例接受手术治疗的甲状腺良性肿瘤患者的临床资料,其中腔镜组78例,行经胸乳入路腔镜甲状腺手术;开放组236例,行传统开放性甲状腺手术。采用统计学方法对两组手术时间、术中出血量、术后第一天引流量、使用止痛药物情况、术后并发症、术后住院时间情况进行对比分析,并进行术后随访。结果:腔镜组手术时间为(82.0±23.5)min,长于开放组(57.7±13.7)min,差异有统计学意义（P＜0.01);腔镜组术中出血量（13.9±7.6）ml低于开放组（33.9±15.4)ml,差异有统计学意义(P＜0.01);术后第一天出血量(22.3±8.7)ml少于开放组（36.0±17.8）ml,差异有统计学意义（P＜0.01);术后住院时间分别为（2.4±0.9）天和（3.6±1.2）天,差异有统计学意义（P＜0.01);腔镜组患者术后使用止痛药的比例小于开放组;腔镜组术后无严重并发症,并发症发生率与开放组无差异且均较低,术后随访半年,未出现甲状腺功能减退和复发。结论:经胸乳入路腔镜甲状腺手术是一种安全、可靠的手术方式,具有出血少、住院时间短、疼痛轻和颈部无疤痕等优势。     

High-dose methotrexate: Preliminary evaluation of a pharmacokinetic approach

Summary Clinical pharmacologic studies have been carried out in patients with head and neck tumors following 36-h continuous infusions of high-dose MTX (1.5 g/m²). The results indicated considerable variation in the amount of MTX in the blood of individual patients. To control these variations, a modified protocol was set up to try to attain the same MTX blood level in all subjects. The protocol has a pharmacokinetic basis and involves determination of the MTX kinetics in each patient. The information thus obtained allows us to compute a 36-h infusion dose so that the MTX plasma levels never exceed a threshold beyond which there is a risk of toxicity to the host.The computation is validated by taking a blood sample 6 h after the beginning of the infusion. If the MTX concentration is higher than its expected value, the infusion rate can then be immediately reduced. Analytical methods that will allow such a computation, the results of the clinical application of this pharmacokinetic approach, and some implications of such a method are discussed.with the technical collaboration of F. Baratier     

Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: A two-centre study

ObjectiveThe transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been increasingly used to treat patients with papillary thyroid cancer (PTC) with improved cosmetic outcomes. This study aimed to explore the safety and efficacy of TOETVA in patients with PTC.Materials and methodsThis retrospective study included TOETVA patients from Yantai Yuhuangding and Xiamen Zhongshan Hospitals. Among the 297 patients studied, 84 had benign nodules (28.3%), 208 had PTC (70.0%), and five had follicular thyroid cancer (1.7%).ResultsThe incidence of transient and permanent recurrent laryngeal nerve injury was 1.3%, while that of transient hypoparathyroidism was 1.0%. Mental nerve paraesthesia was observed in 241 cases (81.1%), while permanent mental nerve paraesthesia was noted in seven cases (2.4%). Abnormal motor function of the lower lip and chin was observed in 12 cases (4.0%). Ten of the 208 patients with PTC (4.8%) underwent total thyroidectomy (TT) and bilateral central neck dissection (CND). A mean 6.6 ± 4.1 and 10.9 ± 4.0 lymph nodes were removed in the unilateral and bilateral surgeries, respectively, with a metastasis rate of 49.0%; a mean 2.7 ± 2.3 and 3.2 ± 2.6 lymph nodes were metastatic, respectively. The parathyroid gland was inadvertently removed in 6.6% and auto-transplanted in 10.6% of patients with unilateral PTC. The non-stimulated thyroglobulin level in the TT and bilateral CND patients was below 1 ng/mL at the 6-month follow-up.ConclusionTOETVA is safe in well-selected patients with unilateral PTC. However, its safety remains unclear in patients treated with TT and bilateral CND.     

Clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy: A prospective randomized study

ObjectivesThis prospective study aimed to explore the clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy.MethodsWe prospectively recruited 45 patients (total 90 patients) who met the eligibility criteria to undergo conventional open thyroidectomy or submental endoscopic thyroidectomy from January 2021 to July 2022 in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. These patients were evaluated using the following indices: number of lymph nodes dissected, complications, pain severity, inflammatory indicators, cosmetic satisfaction, and economic cost. All data were analyzed by the t-test or chi-squared test.ResultsNinety patients were enrolled. The two groups did not significantly differ regarding baseline characteristics. All patients who underwent thyroidectomy had a similar trauma index and increased level of inflammation. There were no significant differences between the open thyroidectomy and submental endoscopic thyroidectomy groups in the total number of lymph nodes dissected, number of positive lymph nodes, drainage volume, and complications. The Vancouver scar score and cosmetic satisfaction score were significantly better in the submental endoscopic thyroidectomy group than the open thyroidectomy group. The submental endoscopic thyroidectomy group had a significantly lower pain scores on postoperative days 1 and 2, less downtime, and cheaper medical and esthetic costs than the open thyroidectomy group.ConclusionCompared with conventional open thyroidectomy, submental endoscopic thyroidectomy did not increase the degree of trauma, had superior clinical efficacy, caused less pain, required a shorter downtime, achieved a better cosmetic effect, and was associated with lower healthcare costs.