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。
目的总结原发性甲状腺鳞癌的诊治经验。方法回顾分析我院1996～2001年收治的12例原发性甲状腺鳞癌患者的临床资料。结果单纯性鳞癌4例，合并甲状腺其它疾病8例。主要临床表现为颈部包块和声嘶。单纯性鳞癌免疫组化甲状腺球蛋白染色阳性3例，阴性1例。12例患者中10例行姑息性切除者于术后1年内死亡，2例行根治性切除者存活时间超过3年。结论原发性甲状腺鳞癌呈高度恶性，可与甲状腺其它良、恶性疾病并存； 要重视对该病的诊断和鉴别诊断，免疫组化甲状腺球蛋白染色可提高确诊率； 根治性手术切除加综合治疗是提高其生存率的关键。
【Abstract】Objective To investigate the correlation of adhesive molecule expressions with potential of invasion and metastasis in papillary thyroid carcinoma (PTC). Methods S-P immunohistochemical method was used to detect CD44v6 and E-cadherin expression in 58 cases of PTC. Results The positive rates of CD44v6 and E-cadherin in PTC were 72.40%and 41.4% respectively. There was a positive correlation between CD44v6 expression and tumor invasive and metastatic potential in PTC (P＜0.05), and a reverse correlation between E-cadherin expression and the potential (P＜0.01).Moreover,there was a reverse correlation between the CD44v6 and E-cadherin expression in PTC(P＜0.05). Conclusion These data show a correlation between the adhesive molecule expression and the potential of invasion and metastasis in PTC. CD44v6 and E-cadherin may be prognostic indicators in PTC.
To investigate the significance of epidermal growth factor receptor (EGFR) in thyroid carcinoma, the expression of EGFR in 81 samples of thyroid carcinoma were determined by immunohistochemical SP method and comparison among thyroid carcinoma, thyroid adenomas and normal thyroid tissue adjacent to the cancer were made. The results showed: EGFR expression was positive in 45 cases (55.6%) of thyroid carcinoma with no positive expression either in thyroid adenomas or normal thyroid tissue adjacent to the cancer (Ｐ＜0.01). There were no statistical differences between EGFR positive rate and thyroid carcinomatous pathological type, clinical stage, depth of invasion, lymph node metastasis or patients′ postoperative survival time (Ｐ＞0.05). This data suggests that expression of EGFR in thyroid carcinoma is associated with its autonomous growth and malignant phenotype, but it is probably not a useful index for assessing the biological behavious and prognosis of thyroid carcinoma.
Ｂｙ ｕｓｉｎｇ ｍｅｄｉｃａｌ ｉｍａｇｅ ｐｒｏｃｅｓｓ ｓｙｓｔｅｍ ｆｏｒ ＤＮＡ ｃｏｎｔｅｎｔｓ，２６ ｃａｓｅｓ ｏｆ ｔｈｙｒｏｉｄ ｔｕｍｏｒｓ ｔｈａｔ ｃｏｍｐｒｉｓｅｄ ａｄｅｎｏｍａ ５，ｐａｎｉｌｌａｒｙ ａｄｅｎｏｃａｒｃｉｎｏｍａ １４，ｆｏｌｌｉｃｕｌａｒ ｃａｒｃｉｎｏｍａ ５，ｕｎｄｉｆｆｅｒｅｎｔｉａｔｅｄ ｃａｒｃｉｎｏｍａ ２ ａｎｄ ｎｏｒｍａｌ ｔｈｙｒｏｉｄ ｔｉｓｓｕｅ ３ ｗｅｒｅ ｄｅｔｅｃｔｅｄ．Ｔｈｅ ＤＮＡ ｃｏｎｔｅｎｔｓ ｉｎ ｔｈｅ ｎｕｍｂｅｒ ｏｆ ｐｏｌｙｐｌｏｉｄｙ ｗｅｒｅ：ｃａｒｃｉｎｏｍａ ｔｈｅ ｈｉｇｈｅｓｔ ｉｎ ａｍｏｕｎｔ，ａｄｅｎｏｍａ ｔｈｅ ｍｅｄｉｕｍ ａｎｄ ｎｏｒｍａｌ ｔｈｙｒｏｉｄ ｔｉｓｓｕｅ ｔｈｅ ｌｅａｓｔ，ｈｅｎｃｅ ｗｅ ｐｒｏｐｏｓｅ ｔｈａｔ ｔｈｅ ｄｅｔｅｒｍｉｎａｔｉｏｎ ｏｆ ＤＮＡ ｐｌｏｉｄｙ ｉｎ ｔｈｙｒｏｉｄ ｔｕｍｏｒｓ ｍａｙ ｂｅ ｕｓｅｄ ａｓ ａｎ ａｄｊｕｖａｎｔ ｔｏ ｅｖａｌｕａｔｅ ｔｈｅ ｐｒｏｌｉｆｅｒａｔｉｖｅ ａｃｔｉｖｉｔｙ ｏｆ ｔｈｙｒｏｉｄ ｔｕｍｏｒ．
Objective To analyze the expressions of galectin-3， human bone marrow endothelial cell-1 （HBME-1），cytokeratin （CK）19， and RET in benign and malignant thyroid tumor and to discuss their clinical significances. Methods The clinicopathologic and immunohistochemical staining data of 131 patients with benign and malignant thyroid tumor were analyzed retrospectively， including 45 patients with malignant thyroid tumor， 86 patients with benign thyroidtumor. The expressions of galectin-3， HBME-1， CK19， and RET in the benign and malignant thyroid tumor were detectedby immunohistochemical staining. Results The positive expression rates of the galectin-3， HBME-1， CK19， and RET in the malignant thyroid tumor were 97.8% （44/45）， 88.9% （40/45）， 100% （45/45）， and 71.1% （32/45）， respectively，which in the benign thyroid tumor were 9.3% （8/86）， 12.8% （11/86）， 37.2% （32/86）， and 8.1% （7/86）， respectively， the differences were statistically significant （P＜0.05）. The diagnostic sensitivity， specificity， and accordance rates were 97.8 %， 90.7%， and 93.1% for the galectin-3， respectively；88.9%， 87.2%， and 87.8% for the HBME-1， respec-tively；100%， 62.8%， and 75.6% for the CK19， respectively；71.1%， 91.9%， and 84.7% for the RET， respectively. Conclusions The expression levels of galectin-3， HBME-1， CK19， and RET in malignant thyroid tumor are significantly higher than those in benign thyroid tumor. Galectin-3， HBME-1， CK19， and RET can be important factors for identifying the benign and malignant tumor and their biological behaviors. Galectin-3 has a high reference value in the diagnosis of thyroid carcinoma.
Objective To further strengthen the understanding of the genesis of thyroid tumors through the analysis of thyroid nodules in the clonal origin. Method The related literatures which discussed the clonality of thyroid nodules were reviewed and analyzed. Results About the clonal origin of thyroid nodules， the X chromosome inactivation detection and single gene mutation detection were the most widely chosen one at present. Most of the materials available at present related to X chromosome inactivation proposed that major part of the thyroid nodules were monoclonal and the malignant cells spreaded by means of the inner lymphatic vessel net，whereas polyclonal and monoclonal thyroid nodules coexisted occasionally. Only BRAF mutation was found of certain importance in clonal origin identification in the thyroid nodules. Conclusions Thyroid nodule is prevalent in clinical practice，while the clonality of thyroid nodules especially the thyroid tumor is not clear. And for the time being the commonly used methods to identify the clonal origin of thyroid nodule are X chromosome inactivation and single gene mutation detection. Published results confirm the finding of X chromosome inactivation methods that the majority of thyroid nodules are monoclonally originated.
Objective To investigate the expression of chemokine receptor CXCR7 and the relation between its expression and clinicopathologic characteristics in papillary thyroid carcinoma. Method The expressions of CXCR7 in 79 cases of papillary thyroid carcinoma and their paracancerous tissues，and 33 cases of benign thyroid lesion tissues were detected by immunohistochemistry. Results The positive expression rates of CXCR7 were 0（0/79），65.8%（52/79），and 30.3%（10/33） in the paracancerous tissues，papillary thyroid carcinoma tissues，and benign thyroid lesions tissues，respectively. The positive expression rate of CXCR7 in the papillary thyroid carcinoma tissues was significantly higher than that in the paracancerous tissues （P＜0.05） or benign thyroid lesion tissues（P＜0.05）. The expression of CXCR7 was correlated with lymph node metastasis （P＜0.05）. Conclusion CXCR7 might take part in tumorigenesis，progression，and lymph node metastasis of papillary thyroid carcinoma.
目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法回顾分析2003年1月至2010年2月期间在我科手术治疗的34例结节性甲状腺肿合并甲状腺微小癌患者的临床资料。结果 病理诊断乳头状癌33例，滤泡状癌1例。行患侧叶全切除术+峡部切除术+对侧叶次全切除术+患侧中央区淋巴结清扫术3例，1例加行患侧改良性颈部淋巴结清扫术; 患侧叶全切除术+峡部切除术+对侧叶次全切除术22例; 患侧叶全切除术+峡部切除术1例; 甲状腺全切除术8例。2例患者出现术后低钙血症，1周后恢复正常，无其他手术相关并发症发生。随访3个月至5年(平均20.2个月)，无一例复发或死亡。结论 甲状腺多发结节有恶性的可能，B超有助于诊断。手术方法多为患侧叶全切除术+峡部切除术+对侧叶次全切除术，预后较好。
ObjectiveTo study the regularity of cervical lymph node metastasis in papillary thyroid carcinoma and a reasonable surgical method. MethodsThe clinical data of 221 cases of papillary thyroid carcinoma treated in this hospital between September 2004 and September 2009 were analyzed retrospectively. ResultsThere were 32 cases treated with total thyroidectomy, 189 patients with subtotal thyroidectomy. Two hundred and two patients with unilateral thyroid carcinoma and 19 patients with bilateral thyroid carcinoma were diagnosed by pathology. The diameter of tumor was 0.2-8.0 cm with an average of 3.5 cm. The amicula invasion was found in 50 cases and mulifocality in 33 cases. The numbers of lymph node dissection were 10-24 with an average of 14.3 in unilateral. The total lymph node metastasis rate was 37.56% (83/221), the lymph node metastasis rate was 33.94% (75/221) in the Ⅵ region, and which was 18.10% (40/221) in the Ⅱ+Ⅲ+Ⅳ region. The rate of cervical lymph node metastasis markedly increased in the patients with the primary tumor diameter gt;1.0 cm, amicula invasion, multifocality, or age gt;45 years in the Ⅵ region and ipsilateral of Ⅱ+Ⅲ+Ⅳ region (Plt;0.05). ConclusionsIn patients with thyroid papillary carcinoma, the most common lymph node metastasis happened in the Ⅵ region, next in the Ⅱ+Ⅲ+Ⅳ region. Lymph nodes of the Ⅵ region should routinely be dissected in the first surgery, the lymph nodes of the Ⅱ+Ⅲ+Ⅳ region should be dissected when the tumor diameter gt;1.0 cm, amicula invasion, multifocality or ultrasonic, CT, and other imaging examinations demonstrated cervical lymph node metastasis.