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.
目的:探讨甲状腺手术中氟比洛芬酯对丙泊酚—瑞芬太尼麻醉效果的影响。方法:将210例择期丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者随机分为对照组和氟比洛芬酯组,每组105例。于切皮前30 min,对照组静脉注入等量生理盐水10mL,氟比洛芬酯组经静脉注入氟比洛芬酯注射液100 mg。分别记录患者麻醉前10 min (T0)、切皮时(T1)、切皮后10 min (T2)、切除腺体时 (T3)以及拔管时 (T4) 的血流动力学 (SBP、DBP、HR) 的变化以及术后口述描述评分(VRS)。结果:与对照组比较, 氟比洛芬酯组T14时SP、DP均降低,两组差别有统计学意义(Plt;005)。氟比洛芬酯组离开手术室时无痛率明显高于对照组,两组差别有统计学意义(Plt;005)。结论:氟比洛芬酯对丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者血流动力学影响小,且减轻术后疼痛,术后恢复更为舒适。
目的 探讨经胸骨前径路内镜甲状腺手术的方法及其临床效果。 方法 采用经胸骨前径路内镜甲状腺手术治疗24例甲状腺良性肿瘤患者，并进行定期随访。 结果 23例手术顺利完成，1例因术中快速冰冻病理诊断为乳头状甲状腺癌而追加常规甲状腺癌根治术。平均手术时间为150 min，术中平均出血量30 ml。2例出现皮下气肿，4例出现胸部皮肤麻木。无喉返神经及甲状旁腺损伤,无术后出血、甲状腺危象等并发症出现。随访1~6个月，所有患者对美容效果非常满意，无近期肿瘤复发者。 结论 经胸骨前径路内镜甲状腺手术是一种美容效果较好的手术方法，手术操作空间的建立和术中控制出血是该术式的两大关键技术。
ObjectiveTo explore the feasibility strategy for patients’ fast track after the operation of thyroid papillary carcinoma with no drainage tube application.MethodsPatients undergone the operation of thyroid papillary carcinoma from June 2017 to March 2018 were enrolled in this retrospective study. All patients were from the same medical teams composed with the same attending doctors. They were divided into two groups according to the drainage tube applied or not. Finally the incidence of postoperative hematoma, incisional infection, and subcutaneous effusion were compared between the two groups, while the length of stay, pain score after operation, and satisfaction of patients were also analyzed.ResultsThe incidences of postoperative hematoma, incisional infection, and subcutaneous effusion were totally similar between the two groups. While the length of stay and pain score were significantly shorter or lower, satisfaction of patients were higher in group of no drainage tube applied (P<0.05).ConclusionsThe operation of total thyroidectomy plus bilateral central lymph node dissection for papillary thyroid cancer without drainage tube will not increase the probability of complications such as hematoma, incisional infection and subcutaneous effusion. On the contrary, it can shorten hospitalization time, reduce wound pain and improve patient satisfaction in the concept of rapid rehabilitation.
Objective To summarize the development of endoscopic thyroid surgery and expound the advantages and disadvantages. Method Reviewed the domestic and foreign literatures on different ways of endoscopic thyroid surgery. Results Gagner tried accomplish subtotal parathyroidectomy with endoscope at the first time in 1996. And then, Hüscher improved the endoscope technology and applied on thyroidectomy in 1997. Henceforth, endoscopic thyroid surgery had developed rapidly, from small neck incision surgery, such as endoscopic assisted small neck incision thyroidectomy, to traceless neck surgery, such as thoraco mammary approach, areola approach, axillary approach, retroauricular approach, combined approach, etc., to traceless body surface skin surgery in recent years, such as natural cavity oral approach. Completed endoscopic surgery makes the incision scar hide or even disappear, which had attracted the attention and learning of thyroid specialist clinicians all over the world. The choice of patients was more and more broad and diverse, and all kinds of approaches had different advantages and disadvantages.Conclusions The advantages, disadvantages, indications and contraindications of various endoscopic approaches are different. According to the location differences of individual thyroid masses and the requirements for aesthetics, the most appropriate endoscopic thyroid approach is selected to achieve the optimal solution of manual approach.
ObjectiveTo investigate the clinical value of cervical vascular color Doppler ultrasound for dignosis of nonrecurrent laryngeal nerve before thyroid surgery. MethodsThere were 1931 cases of thyroid patients treated between January 2010 to Jule 2014, group these patients according to the results of preoperative chest radiograph examination, the chest radiograph shows abnormal vessels image were group A (45 cases), no abnormalities were group B (1886 cases). Before operaton, made patients of group A to have routine carotid duplex ultrasound to identify whether the right subclavian artery abnormalities. All patients were exposed to conventional methods of recurrent laryngeal nerve during surgery. ResultsThe 45 patients of group A, chest angiography showed 17 cases with right subclavian artery abnormalities, they were confirmed that all the 17 patients were nonrecurrent laryngeal nerve by surgery, no damage cases. The other 28 cases showed a normal right subclavian artery and no cases of nonrecurrent laryngeal nerve. The 1886 patients in group B, surgical exploration found four cases with nonrecurrent laryngeal nerve, injury in 1 case. The 21 patients whose nonrecurrent laryngeal nerve were on the right side, there were no left side with nonrecurrent laryngeal nerve and no co-exist cases of nonrecurrent and recurrent laryngeal nerve. The average exposure time of nonrecurrent laryngeal nerve in patients of group A (17 cases) was significantly shorter than that group B[(4.28±1.08) min vs. (15.50±2.08) min, t=-15.978, P=0.000]. ConclusionsThe cervical vascular color Doppler ultrasound examination before thyroid surgery can be adjuvant used, if there is the right subclavian artery abnormalities, it showes that there is the right side nonrecurrent laryngeal nerve. So as to effectively prevent the damage of nonrecurrent laryngeal nerve during thyroid surgery.
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.
【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
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。