ObjectiveTo summarize the experiences and lessons of diagnosis and treatment of follicular thyroid carcinoma (FTC) with lymph node and lung metastases.MethodThe clinicopathologic data of a case of FTC with metastases of cervical, mediastinum, axillary lymph nodes, and bilateral lungs were analyzed retrospectively.ResultsThe case was a 39 years old male patient, who was diagnosed with the right FTC with multiple metastases. The total thyroidectomy+lymph node dissection in bilateral central and bilateral neck regions+lymph node dissection in the left axillary was intended to perform in the Department of Thyroid and Parathyroid Surgery of the West China Hospital. During the operation, the upper mediastinal lymph node fusion was found, and the tumor was tightly adhered with the recurrent laryngeal nerve, the signal was lost after the adhesion separation. In the right central area, the enlarged lymph nodes penetrated down into the upper mediastinum. More enlarged lymph nodes extended upward into the subclavian area in the left armpit. Considering a longer operation time and about 2 000 mL bleeding amount, the mediastinal and left neck operation was decided to perform in the second stage after consulting with the thoracic surgeon. At more than 6 months after the operation, the patient underwent the mediastinal lymph node dissection+superior vena cava (SVC) restoration+metastatic tumor resection+SVC shunt operation in the Department of Thoracic Surgery of the West China Hospital. The operation was successful, without hypocalcemia, dyspnea, and other complications. At 8 months after the operation, the third operation was performed in the Department of Thyroid and Parathyroid Surgery of the West China Hospital, that was, total residual thyroidectomy+left central and left cervical lymph node dissection+left axillary lymph node dissection (level Ⅱ–Ⅲ). The postoperative pronounce didn’t change, without hypocalcemia and other complications. Three times of iodine ablation therapy were performed in the West China Hospital. The occupy didn’t be found by the neck ultrasound and the pulmonary metastasis was stable by the CT during the regular follow-up.ConclusionsAccording to this case, neck surgery with SVC syndrome, SVC syndrome should be treated preferentially. For patient with complicated condition, unconventional approaches could be selected according to actual condition of patient, and staging surgery might be a good choice.
目的探讨胰腺血管活性肠肽瘤（VIPoma）的临床、实验室和影像学特点，以及诊断方法和治疗手段。 方法报道1例胰腺VIPoma，同时检索国内文献得到49例胰腺VIPoma患者临床资料，并对此50例病例进行分析。 结果分泌性腹泻、低血钾和代谢性酸中毒是胰腺VIPoma的主要临床表现，血浆血管活性肠肽（VIP）水平增高具有诊断价值。经手术治疗，腹泻症状可减轻或消失；对于远处转移患者，生长抑素、化疗、干扰素等治疗均有效。 结论VIPoma早期诊断困难，确诊依赖于典型临床症状、血浆VIP水平、影像学检查以及免疫组化检查。手术切除可改善预后，生长抑素等治疗可缓解症状，发生转移者也应积极治疗。
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 investigate clinical features of accidental parathyroid adenoma (APTA) and to explore diagnosis and treatment strategies of APTA. Methods From February 2009 to December 2016, the patients who would receive the thyroid surgery and were accidentally found the parathyroid adenoma by preoperative examination in the Department of Thyroid & Parathyroid Surgery, West China Hospital of Sichuan University were enrolled in the research. The clinical characteristics, surgical procedure, results of postoperative follow-up were analyzed retrospectively, and which were compared between the patients with APTA and the other patients diagnosed as primary parathyroid adenoma or received thyroid surgery (1 : 4 chosen randomly) in the same period. Results From February 2009 to December 2016, the patients who treated with thyroid surgery and were diagnosed as the primary parathyroid adenoma in our center were 5 881 and 251 respectively. Twenty-six patients with APTA were found in this research. The incidence rate of APTA was 0.44% (26/5 881), accounted for 10.4% (26/251) of the primary parathyroid adenoma. The positive rates of the ultrasound and the parathyroid scintigraphy were 69.2% (18/26) and 72.7% (8/11), respectively. The abnormal rate of the bone mineral density examination was 85.7% (6/7). The preoperative PTH was (38.17±40.69) pmol/L (3.40–181.20 pmol/L), and the serum calcium was (2.73±0.27) mmol/L (2.22–3.23 mmol/L). The number of detected parathyroid adenoma was 29, which were 55.2% (16/29) in the right-lower, 6.9% (2/29) in the right-upper, 27.6% (8/29) in the left-lower, and 10.3% (3/29) in the left-upper location. The rate of single parathyroid adenoma was 88.5% (23/26) and the maximum diameter of parathyroid adenoma was (21.72±9.65) mm. There was 13 cases (44.8%) of the A1 type and 16 cases (55.2%) of the B1 type in these 29 parathyroid adenomas. The rates of the recurrence, postoperative transient hypoparathyroidism, and permanent hypoparathyroidism were 7.7% (2/26), 30.8% (8/26), and 3.8% (1/26), respectively. Additionally, the preoperative PTH and serum calcium levels of the patients with APTA were significantly lower as compared with the primary parathyroid adenoma (P<0.001,P<0.001), which were significantly higher as compared with those of the patients received thyroid surgery without APTA in the same period (P=0.001, P<0.001). Conclusions APTA is a specific type of asymptomatic primary hyperparathyroidism. Examinations for PTH and serum calcium levels before thyroid surgery are important for finding APTA. For the patients with APTA, it is safe and effective to carry out exploratory parathyroidectomy with thyroid surgery at the same time.
ObjectiveTo investigate the risk factors of accidental parathyroidectomy following thyroid surgery.MethodsData of patients who accepted at least total thyroidectomy in the Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases between January 2013 and June 2016 was collected retrospectively. According to the appearance or non-appearance of parathyroid gland in the specimens after pathologic examination, the patients were divided into accidental parathyroidectomy group and non-accidental parathyroidectomy group. Clinical data was collected for comparison between the two groups. The risk factors of accidental parathyroidectomy were indentified with univariate analysis and multivariate analysis.ResultsA total of 983 patients, 50 patients in the accidental parathyroidectomy group and 933 patients in the non-accidental parathyroidectomy group, were included in the study. Incidence of temporary hypoparathyroidism was 66.0% (33/50) in the accidental parathyroidectomy group and 36.2% (338/933) in the non-accidental parathyroidectomy group, there was significant difference between the two groups (χ2=19.903, P<0.05). Incidence of permanent hypoparathyroidism was 2.0% (1/50) in the accidental parathyroidectomy group and 0.4% (4/933) in the non-accidental parathyroidectomy group, and there was no significant difference between the two groups (χ2=2.315, P=0.128). Univariate analysis showed that bilateral central lymph nodes dissection (P=0.004) and the number of identified parathyroid glands ≤2 (P=0.002) were risk factors of accidental parathyroidectomy. Multivariate analysis showed that bilateral central lymph nodes dissection [OR=2.553, 95% CI was (1.236, 5.277), P=0.011] and the number of identified parathyroid glands ≤2 [OR=2.819, 95% CI was (1.423, 5.581), P=0.003] were independent risk factors of accidental parathyroidectomy.ConclusionsAfter careful consideration of the possible risks and benefits, bilateral central lymph nodes dissection should be performed rationally. Thyroid surgeons should improve the ability of identification of parathyroid gland to reduce the incidence of accidental parathyroidectomy.
ObjectiveTo investigate the application value of indocyanine green (ICG) fluorescence imaging technology for determining the blood supply of parathyroid in thyroid surgery.MethodsThe patients who underwent total thyroidectomy and bilateral central lymph node dissection for papillary thyroid carcinoma (PTC) from June 1, 2017 to January 1, 2018 were prospectively enrolled and then divided into a study group and control group randomly. The study group used the ICG fluorescence imaging technology to evaluate the blood supply of the parathyroid glands, while the control group assessed the blood supply by naked eyes, then determined that whether the parathyroid glands were retained in situ or autotransplanted. The incidence of hypoparathyroidism, length of hospital stay, and parathyroid hormone (PTH) were compared between the two groups.Results① A total of 60 patients with PTC were included in the study, and 30 patients in each group. There were no significant differences in the baseline informations of the two groups such as the gender, age, comorbidities, and preoperative PTH, Ca2+ levels, etc. (P>0.05). ② The ICG score of type A parathyroid glands (except type A3) was lower than that of type B parathyroid glands (0.99±0.38 versus 1.45±0.58, t=–2.395, P<0.05). ③ The length of postoperative hospital stay was shorter in the study group than in the control group (t=–2.159, P=0.035). ④ The ICG fluorescence imaging could significantly reduce the incidence of temporary hypoparathyroidism (χ2=5.079, P=0.024). The incidence of permanent hypoparathyroidism was not statistically different between the two groups (χ2=1.000, P=0.317), and only 1 case appeared in the control group. ⑤ There were no statistically significant differences in the PTH and serum Ca2+ levels at day 1, month 1, month 3, and month 6 after the surgery between the two groups (P>0.05). ConclusionICG fluorescence imaging technology could be used to determine blood supply of parathyroid in situ in real time during operation. Further studies are needed to confirm this conclusion.