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91.
腔镜辅助下行分化型甲状腺癌功能性颈淋巴结清扫术(附7例) 总被引:1,自引:0,他引:1
目的:研究腔镜辅助下行分化型甲状腺癌颈淋巴结清扫术的可行性,探索手术治疗分化型甲状腺癌的新方法。方法:为7名分化型甲状腺癌患者行腔镜辅助下功能性颈淋巴结清扫术,其中4例为甲状腺癌联合根治术。就手术的清扫范围、手术时长、术中失血量、术后病理结果、并发症、患者满意度等多方面进行分析。结果:全部病例手术顺利,清扫范围可以达到传统开放式手术范围。整体手术时长平均214分钟,平均失血量约137ml。病理显示颈部各区清扫组织均可见数目不等的淋巴结,并有部分癌转移。伤口愈合良好,无并发症,患者满意度100%。结论:在腔镜辅助下行颈淋巴结清扫术是安全可行的,较完全腔镜式和传统开放式手术,在美容、微创、疗效三方面互有补裨,相得益彰。该技术可用于分化型甲状腺癌的手术治疗。 相似文献
92.
超声造影在甲状腺良性结节选择介入治疗方式中的价值研究 总被引:1,自引:0,他引:1
目的探讨超声造影在甲状腺良性结节选择介入治疗方式的应用价值。方法对85个甲状腺混合性良性结节进行超声造影。结节增强范围超过自身3/5的进行射频消融治疗;增强范围不到自身3/5的结节进行无水乙醇硬化治疗。治疗后即刻或1周后再次行超声造影,评估两种治疗方法的治疗效果。结果 85个甲状腺混合性良性结节中,33个结节进行射频消融治疗,一次性治疗有效率87.9%,二次性治疗有效率12.1%;52个结节进行无水乙醇硬化治疗,一次性治疗有效率88.5%,二次性治疗有效率11.5%;两者治疗效果比较差异无统计学意义。结论超声造影对甲状腺良性结节选择合适的介入治疗方式具有决策价值。 相似文献
93.
目的 观察细针穿刺抽吸活检(FNAB)诊断甲状腺乳头状癌(PTC)准确率的影响因素。方法 回顾性纳入468例术前接受FNAB并经术后病理确诊的单发PTC患者,观察临床、超声及病理学特征对FNAB诊断准确率的影响。结果FNAB诊断PTC的准确率为71.37%(334/468)。PTC结节最大径及其位置是影响FNAB诊断准确率的因素。结节最大径0.7 cm为FNAB诊断PTC的最佳截断值;FNAB对最大径<0.7 cm及 ≥ 0.7 cm结节的诊断准确率分别为62.96%(119/189)和77.06%(215/279)。FNAB诊断穿刺困难区及容易区PTC的准确率分别为52.53%(52/99)和76.42%(282/369),诊断容易区最大径 ≥ 0.7 cm、困难区最大径 ≥ 0.7 cm、容易区最大径<0.7 cm及困难区最大径<0.7 cm PTC的准确率分别为80.43%(185/230)、61.22%(30/49)、69.78%(97/139)及44.00%(22/50)。结论 PTC最大径及其位置均为FNAB诊断准确率的影响因素。 相似文献
94.
95.
孤立性肺结节(SPN)是放射学常见的诊断难题,笔者应用生物医学工程技术,对参考体模和SPNCT初步研究结果作报告。我们设计并制成参考体模和参考SPN,能对任何密度的SPN作为比较标准,评价所有的SPN,参考体模用组织等效材料,仿真模拟胸部的解剖并组成四或五层的横断面。参考SPN为各种大小的园柱形和不同的密度,应用CT能获得其生物物理参数(形态、大小、密度、三维座标等)这有利于CT诊断的质量保证(QA)和质量控制(QC)。 相似文献
96.
Ectopic thyroid tissue can be seen anywhere along the path of the descending glands, but it is rarely seen in the abdominal
cavity. An ectopic thyroid was encountered incidentally in the pancreas of a 50-year-old woman who underwent a bilateral truncal
vagotomy and pyloroplasty for a duodenal ulcer. There were no signs or symptoms of a thyroid tumor. 相似文献
97.
JOHN M. Chaplin CHRISTOPHER J. OBrien EDWARD B. Mcneil Kourosh Haghighi 《ANZ journal of surgery》1999,69(9):625-628
Background : Total thyroidectomy is widely practised in Australasia for papillary and follicular thyroid carcinoma. Data from large overseas series have demonstrated that patients with these cancers may be separated into risk groups based on clinicopathological prognostic factors. Furthermore, evidence suggests that low-risk patients may be safely treated with less than total thyroidectomy. The aim of the present paper was to determine what proportion of our patients with papillary and follicular thyroid cancer were in the low-risk group in order to select candidates for less aggressive treatment. Methods : A prospectively documented series of 175 previously untreated patients with papillary and follicular thyroid carcinoma, treated principally by total thyroidectomy over a 10-year period, was divided into risk groups using the Mayo Clinic, Lahey Clinic and Memorial Hospital prognostic scoring systems. Complication rates for 103 patients treated by total thyroidectomy were also studied and reported. Results : Women outnumbered men by 2.3:1. There were 128 papillary carcinomas (73%) and 47 follicular cancers (27%). These tumours were < 4 cm in diameter in 81% of patients, and 41% of patients were 40 years of age or younger. Low-risk patients accounted for 75, 81 and 45% of the study group, respectively, when the three prognostic scoring systems were applied to our patient population. The rates for recurrent laryngeal nerve palsy and permanent hypoparathyroidism for patients having total thyroidectomy were 1 and 1.9%, respectively. In the low-risk group there were no permanent complications. Conclusion : Most patients treated at Royal Prince Alfred Hospital during the past 10 years were low-risk patients who may have been eligible for less aggressive surgical treatment. 相似文献
98.
Masahiko Higashiyama Ken Kodama Hideoki Yokouchi Koji Takami Kazuyoshi Motomura Hideo Inaji Hiroki Koyama 《Surgery today》1999,29(7):670-674
A 63-year-old man was referred to our institute for the treatment of squamous cell carcinoma of the upper lobe of his right
lung. A right upper lobectomy of the lung was performed with a mediastinal lymph node dissection. The postoperative pathological
examination of the dissected specimens revealed one of the superior mediastinal lymph nodes to be morbid with micrometastasis
of occult thyroid cancer, while no node involvement was seen due to lung cancer. A right lobectomy of the thyroid gland with
a modified radical neck dissection was done 4 years later after the confirmation of the absence of any recurrent sign of lung
cancer. In the resected specimen, papillary thyroid microcarcinoma was observed with several intraglandular metastases and
right regional lymph node involvement. Eight months later, a new primary lung cancer developed in the left lung, and a left
upper lobectomy of the lung with a mediastinal lymph node dissection was performed. At that time, the absence of mediastinal
lymph node metastasis from lung cancer or thyroid cancer was confirmed. Mediastinal lymph node involvement as the initial
manifestation of occult thyroid cancer in surgical treatment for lung cancer is rare, but it is important to be aware of the
possibility of incidentally detecting occult thyroid cancer in surgical dissections in this area for lung cancer. The appropriate
surgical treatment should be determined while carefully considering the prognosis of the lung cancer as well as that of any
coexisting malignancy. 相似文献
99.
Takeo Kimoto Kouya Suemitsu Izumi Eda Toshinari Shimizu Mitsuru Ohtani Tohru Nabika 《Surgery today》1999,29(9):880-883
Thyroid masses are a common clinical finding, and their management remains controversial. The purpose of this study was to
evaluate the clinical effect of performing routine ultrasound (US) examinations and US-guided fine-needle aspiration biopsy
(US-FNAB) in the management of diffuse or nodular goiter diagnosed by mass screening. Mass screening carried out from 1993
to 1996 revealed 444 women with goiter, 322 of whom had diffuse goiter and 122 had nodular goiter. All of these patients underwent
US examination, the results of which determined that 169 should undergo US-FNAB to confirm an accurate diagnosis of their
thyroid tumors. Histological examinations after surgical resection revealed that 12 of the 322 patients with diffuse goiter
(3.7%) and 23 of the 122 with nodular goiter (18.9%) had malignant tumors. Among the 61 thyroid tumors surgically verified,
US-FNAB yielded a sensitivity rate of 93%, a specificity rate of 81%, and an accuracy rate of 90%. Insufficient aspiration
was obtained from 5%. Performing US-FNAB-resulted in an elevation in the percentage of malignant tumors yielded at surgery
of up to 72%. Thus, ultrasonography followed by US-guided-FNAB could be a useful routine method of evaluating thyroid tumors
detected by mass screening. Moreover, a greater number of unnecessary thyroid operations can be avoided by performing US-FNAB
rather than FNAB alone. 相似文献
100.
Use of somatostatin analogue scintigraphy in the localization of recurrent medullary thyroid carcinoma 总被引:1,自引:0,他引:1
Lluís Bernà Ana Chico Xavier Matías-Guiu Eugenia Mato Ana Catafau Carmen Alonso Josefina Mora Didac Mauricio José Rodríguez-Espinosa Carina Marí Albert Flotats Juan-Carlos Martín Montserrat Estorch Ignasi Carrió 《European journal of nuclear medicine and molecular imaging》1998,25(11):1482-1488
Detection of recurrence of medullary thyroid carcinoma (MTC) remains a diagnostic problem. Increased serum tumour marker levels
frequently indicate recurrence while conventional imaging techniques (CIT) are non-diagnostic. In this study, we performed
indium-111 octreotide scintigraphy and CIT in a series of 20 patients with MTC presenting with elevated serum tumour markers
after surgery. 111In-octreotide whole-body studies detected 15 pathological uptake foci in 11 of the 20 patients studied and CIT detected 17
lesions in 11 of the 20 patients. Ten patients underwent reoperation, five of them with positive 111In-octreotide scintigraphy and CIT and two with positive isotopic exploration and negative CIT. Surgical findings demonstrated
that the results of isotopic study and CIT had been false-positive for MTC in one case (sarcoidosis). The six patients with
true-positive 111In-octreotide studies had significantly higher basal calcitonin (CT) and carcinoembryonic antigen (CEA) levels than the patients
with negative isotopic studies. The expression of somatostatin receptor (SSTR) subtypes by PC-PCR could be investigated in
four cases with a positive isotopic study. Among the three cases with a true-positive study, SSTR2, the SSTR subtype that
preferentially binds to the somatostatin analogue octreotide, was detected in two, SSTR5 was demonstrated in the three, and
SSTR3 was detected in one. No subtype of SSTR was detected in the case with a final diagnosis of sarcoidosis. We conclude
that 111In-octreotide has limited sensitivity in detecting recurrence in patients with MTC, although its sensitivity may improve with
high serum CT levels. This radionuclide imaging technique should be employed when conventional imaging techniques are negative
or inconclusive or when the presence of somatostatin receptors may provide the basis for treatment with somatostatin analogues.
Received 5 April and in revised form 27 July 1998 相似文献