ObjectiveTo investigate the feasibility of dissecting the external branch of the superior laryngeal nerve using endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring. MethodsThe clinical data of 30 patients who underwent the gasless nilateral subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from October 2023 to February 2024 were retrospectively analyzed. ResultsAll operations were successfully completed under endoscopy approach without transfer to open surgery. A total of 29 cases of the external branch of superior laryngeal nerves were revealed in 30 cases, the revealed rate was 96.7%. The time for dissecting the external branch of the superior laryngeal nerve was 2–6 min [(3.6±2.3) min]. There was no obvious sound change related to the injury of the external branch of superior laryngeal nerve in postoperative patients. ConclusionFor the modified endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring, excellent anatomical protection of the external branch of the superior laryngeal nerve can be obtained.
Objective To understand anatomy of parathyroid gland and explore its application value in protection of parathyroid gland function during thyroidectomy. Methods The literatures, which were associated with the parathyroid anatomy and hypoparathyroidism were collected. The origin, function, anatomical location, number, blood supply, lymphatic system of the parathyroid gland and its relationship with surrounding tissues of parathyroid gland and its clinical significance in the thyroidectomy, were reviewed. Results The position of the superior parathyroid gland was relatively constant, and the inferior parathyroid gland was more likely to be ectopic. The number of the parathyroid gland was uncertain. The mainstream view was that the arterial supply of the parathyroid glands was mainly ensured by the inferior thyroid artery, a few by anastomosis of the superior and inferior thyroid arteries, or by the superior thyroid artery. However, the alternative view was that the blood supply of the parathyroid gland was not mainly derived from the inferior thyroid artery. The parathyroid gland was not easily distinguished from the adipose tissue and lymph node. Whether there was an independent lymphatic system in the parathyroid gland was still controversial. In the thyroidectomy, the parathyroid gland and its blood supply were reserved or protected by distinguishing from the Zuckerkandl tubercle, recurrent laryngeal nerve, and parathyroid specific attachment fat, which were identified by utilizing of the nanocarbon, loupe magnification, etc.. Especially in the central lymph neck dissection, the main thyroid artery trunk and its important branches should be carefully dissected or retained through the gentle capsular dissection and the correct use of energy devices for vessel sealing. The parathyroid gland in situ was reserved according to the parathyroid type. If it was not possible to be preserved, the parathyroid autotransplantation was necessary during the thyroidectomy. Conclusions Understanding origin and location of parathyroid gland, it could provide a direction for searching parathyroid gland during thyroidectomy. Being familiar with blood supply of parathyroid gland makes it possible to protect blood vessel and preserve parathyroid gland. Gentle capsular dissection, rational use of energy device, and indocyanine green angiography seem to be more important. Number of parathyroid gland allows us to treat each parathyroid gland as the last one, if it is not preserved in situ , parathyroid gland need to be autografted to avoid hypoparathyroidism.
目的 探讨甲状腺手术方式和喉返神经损伤（RLN）的关系。 方法 回顾性分析2009年1月至2012年6月期间于笔者所在医院科室接受开放性甲状腺手术的985例患者的临床资料，探讨甲状腺手术方式和RLN损伤的关系。 结果 本组患者术后发生RLN损伤26例（2.6%），未发生RLN损伤959例（97.4%）。logistic回归分析结果显示，年龄、性别、超声刀应用、麻醉方式及肿块良恶性与RLN损伤均无关（P＞0.05），而手术范围（OR=3.726，P=0.007）和显露RLN（OR=0.302，P=0.006）则是RLN损伤的影响因素，行扩大性手术及未显露RLN者的RLN损伤率较高。 结论 在开放性甲状腺手术中，手术范围以及显露RLN是RLN损伤的独立影响因素，术中显露并注意保护RLN，对避免RLN损伤具有重要意义。
目的探讨经峡部径路行甲状腺手术的优、缺点。方法回顾性总结分析近8年来我院收治的1 699例患者经峡部径路行甲状腺手术的临床资料。结果该术式术野暴露充分，手术时间平均65 min，术中出血量平均50 ｍl。术后喉返神经损伤8例(均为单侧)，68例术后出现短暂性低钙血症，3例术后出血，其中2例发生于术后2 h，出血量200 ml, 行手术止血； 1例发生于术后1 h，出血量100 ml，给予压迫止血和药物止血后，出血停止，余恢复均好。结论经峡部径路行甲状腺手术，能开阔术野和拓宽手术空间，能立即解除患者颈部紧缩感，保持术野清晰，减少术中出血和喉返神经损伤，减少低钙血症及继发性甲状腺功能低下，避免术后呼吸困难、窒息等并发症的发生。
Objective To explore anatomical features and variation of non-recurrent laryngeal nerve and to summarize identification method, operation skill, and damage treatment experience of it. Method The clinical data of 15 patients with non-recurrent laryngeal nerve in 4 054 patients who underwent thyroidectomy from our division by the same medical group from January 2006 to January 2016 were retrospectively analyzed. Results A total of 6 626 recurrent laryngeal nerve (left side 3 248, right side 3 378) were exposed in 4 054 cases. Fifteen patients with non-recurrent laryngeal nerve were detected with an incidence of 0.23% (15/6 626), all located on the right side. There were 3 males and 12 females. There were 3 cases of type Ⅰ, 10 cases of type Ⅱa, 2 cases of type Ⅱb. And 2 patients with non-recurrent laryngeal nerve were injured. Conclusions Incidence of non-recurrent laryngeal nerve is lower, most of which occur on right side of neck, there is a high injury rate for its special anatomical location. It’s key to prevent nerve injury for careful interpreting preoperative auxiliary examination results and improving awareness of non-recurrent laryngeal nerve, fining dissection, conventional exposuring recurrent laryngeal nerve, and accurate using nerve monitor during operation.
Objective To evaluate whether the classification of parathyroid can be used to evaluate how difficult it is that the parathyroid glands get preserved in situ during thyroid surgery. Methods Clinical date were retrospectively collected from the patients with thyroid nodules, who had undergone the initial thyroidectomy in the Department of Thyroid Surgery, West China Hospital of Sichuan University between January 2014 and June 2016. The number of parathyroid glands was counted according to the classification of parathyroid. It got comparative analysis that the rates of parathyroid glands in situ among the different types. Results A total of 996 patients were included in the study, and 3 269 pieces of parathyroid glands were identified. The mean number of parathyroid identification was 3.3 pieces. These parathyroid glands consisted of 77.5% (2 532/3 269) type A and 22.5% (737/3 269) type B. The rate of parathyroid glands in situ was 77.1% (1 951/2 532) in type A, and 80.7% (595/737) in type B, the difference was significant (P=0.03). And the rate of parathyroid glands in situ in type A1 was significantly higher than that in type A2 (80.5%vs 21.4%,P<0.001). The parathyroid of type A3 couldn’t get preserved in situ. The rate of superior parathyroid glands in situ in type B1 was higher than that in type A1 (97.5%vs 93.7,P<0.01). But the rate of inferior parathyroid glands in type B1 was closed to that in type A1 (62.2%vs 65.7%,P=0.23), and both the rates were significant less than that in type B2 (86.0%) and in type B3 (90.2%),PA1vs B2=0.001,PA1vs B3<0.001,PB1vs B2=0.004,PB1vs B3=0.001. Conclusion The classification of parathyroid can be used to evaluate effectively how difficult it is that the parathyroid glands get preserved in situ during thyroid surgery.
Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). Methods One hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. Results There was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P＜0.001); the surgical complications showed no significant difference between the HS and CH group (Pgt;0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P＜0.05); the surgical complications after learning curve were significantly lower than that in learning curve in HS group (P＜0.001). Conclusion HS provides significant advantages over conventional hemostasis in open thyroid surgery. However, it can’t be used in a blindly exclusive way but be combined with conventional knot tying appropriately.
【Abstract】ObjectiveTo discuss how to identify and protect the parathyroid glands (PTGs) and their blood supplies during thyroidectomy. MethodsProtective measure of PTGs and their blood supplies were observed during the operation by eyes, as well as the occurrence of hypoparathyroidism after operation. Patients with syndrome of hypocalcaemia were given calcium and vitamin D3 supplementation until the serum calcium became normal. ResultsThere was no PTG found in 13 cases (13/259), 242 superior PTGs were found which were almost consistently (91.32%) located in the back sides of the thyroid glands and on the level of inferior edge of the thyroid cartilage. The blood supplies of 61 superior PTGs were often (68.85%) from the upper branch of inferior thyroid artery (ITA). Total 426 inferior PTGs were found, and the locations of which were more variable. Approximately 49.77% were located in the inferior 1/3 part of the back sides of the thyroids， 24.88% were positioned immediately to the inferior thyroid, where the ITA branches inserted into the thyroid. The blood supplies of 128 inferior PTGs were also mostly (80.47%) from the inferior branches of ITA system. There was no permanent hypoparathyroidism occurred and hypocalcemia after operation was happened to 27 patients, in which one patient of reoperation was underwent unilateral thyroidectomy, 3 patients were underwent unilateral thyroidectomy and contralateral subtotal thyroidectomy, 4 patients were underwent total thyroidectomy, 7 patients were underwent total thyroidectomy plus bilateral central neck dissection, 11 patients were underwent total thyroidectomy plus unilateral neck dissection, and one patient was underwent total thyroidectomy plus bilateral neck dissection. ConclusionThe blood supplies of PTGs are associated with their locations. The PTGs can be exposed and protected by eyes during operation. To prevent postoperative hypoparathyroidism, the PTGs should be protected in situ through meticulous dissection without
Objective To evaluate if performing thyroidectomy through small incision has any notable aesthetic impact on patients compared with larger incision. Methods Thirty consecutive patients underwent thyroidectomy were enrolled from March 2008 to June 2008 in this prospective randomized pilot study. The incision length was 6 cm in the small incision group and 9 cm in the larger incision group. After 3 years follow-up，the scar aesthetics were evaluated by patients and surgeons using the Patient and Observer Scar Assessment Scale （POSAS），Vancouver Scar Scale （VSS），respectively. Digital photographs about scars were taken and assessed by non-research related viewers. Results There were 13 cases who received scar aesthetic assessment in both groups. The demographic characteristics of both groups were comparative. The overall patients’ satisfactions for the small incision group and the larger incision group were （2.5±1.9） scores and （2.2±1.5）scores， respectively （P=0.55）. There were no significant differences in scar assessment scale score as for other scar assessment scales （including VSS score，PSAS score，and OSAS score） between the two groups. The evaluation of digital photographs about scars by non-research related viewers was no significant difference （P＞0.05）. Conclusion Larger cervical scar in thyroidectomy does not decrease patients’ satisfaction with their scar results.