ObjectiveTo investigate the clinical value of elective central compartment lymph node dissection for cN0 papillary thyroid carcinoma. MethodThe clinical data of 326 patients with cN0 papillary thyroid carcinoma from January 2007 to December 2011 in this hospital were analyzed retrospectively. ResultsThe lymph node metastasis incidence was 35.89%(117/326) in 326 patients with cN0 papillary thyroid carcinoma, which in the patients with age < 45 years, tumor diameter > 1 cm, and thyroidal tumor infiltrated envelope were significantly higher than those in the pati-ents with age≥45 years, tumor diameter≤1 cm, and thyroidal tumor not-infiltrated envelope (age:46.56% versus 28.72%, P=0.001;tumor diameter:44.44% versus 26.45%, P=0.001;infiltrated envelope:50.00% versus 33.09%, P=0.020).Multivariate analysis showed that age < 45 years and tumor diameter > 1 cm were independent risk factors for central compartment lymph node metastasis of cN0 papillary thyroid carcinoma.There were 6 cases of temporary recu-rrent laryngeal nerve injury, 18 cases of temporary hypoparathyroidism, 4 cases of temporary superior laryngeal nerve injury, and 1 case of acute caryngeal edema.There were no complications such as permanent laryngeal nerve injury and permanent hypoparathyroidism.Three cases had lateral cervical lymph node metastases during a follow-up of 7-67 months (mean 31.2 months). ConclusionsIt is necessary and safe to perform elective central compartment lymph node dissec-tion for cN0 papillary thyroid carcinoma.The elective central compartment lymph node dissection should be considered in patients with cN0 papillary thyroid carcinoma, especially in patients with age of < 45 years and tumor diameter > 1 cm.
ObjectiveTo investigate the early diagnosis and proper treatment of acute mesenteric venous thrombosis (AMVT). MethodsThe clinical data of 105 cases of AMVT treated from January 2000 to December 2013 were analyzed retrospectively. ResultsThe diagnostic accuracy of ultrasonography and abdominal contrast-enhanced CT was 67.6% (71/105), 88.0% (81/92) respectively. The accuracy rate of abdominal cavity puncture or abdominal drainage in the diagnosis of intestinal necrosis was 100% (38/38). All cases received anticoagulation and thrombolysis as soon as the definite diagnosis of AMVT were made. Twenty-five cases underwent emergency operation due to the bowel necrosis at the visiting time, Anticoagulation and thrombolysis were performed in 80 patients, of which 7 patients received surgical treatment because of ineffective anticoagulation and thrombolytic therapy. Thrombectomy was performed in 15 cases simultaneously. Surgical treatment of 32 cases, 30 cases were cured and 2 patients died of multiple organ failure or short bowel syndrome within 1 month after operation. Seventy-three cases were treated with anticoagulation therapy alone, 72 patients were cured and discharged, the effective rate was 90.0%, another 1 case died due to cerebral hemorrhage within 1 month after operation. ConclusionsEarly diagnosis of AMVT and bowel necrosis, timely and accurate anticoagulation and thrombolysis, and proper surgical intervention can often achieve satisfactory results.
目的 探讨甲状旁腺腺瘤所致无症状原发性甲状旁腺功能亢进症（PHPT）的诊断和治疗。方法 回顾性分析中国医科大学附属第一医院1990年1月至2013年4月期间收治的24例甲状旁腺腺瘤所致无症状PHPT患者的临床资料。结果 24例甲状旁腺腺瘤所致无症状PHPT患者中男9例，女15例；年龄（47.92±12.96）岁。均无骨关节疼痛、病理性骨折、泌尿系结石或胃肠道症状等典型PHPT的临床表现，均为体检和并存或误诊为甲状腺疾病时发现。24例患者术前血钙升高18例，正常6例；血磷降低7例，正常17例；16例术前行血甲状旁腺激素检测患者中11例升高，正常5例；22例患者术前测定血碱性磷酸酶升高9例，正常13例。血钙与甲状旁腺激素均正常者4例，其中1例为体检时超声发现甲状旁腺病变，3例为手术治疗甲状腺疾病术中探查发现。24例患者术前均行超声检查，15例行甲状旁腺ECT检查，14例行甲状旁腺增强CT检查，阳性率分别为66.67% （16/24）、93.33% （14/15）及78.57% （11/14）。15例术前定性定位检查获得明确诊断，5例定性或定位检查高度怀疑甲状旁腺病变，4例术前误诊为甲状腺病变。均行甲状旁腺腺瘤切除，其中甲状旁腺腺瘤位于左侧上位2例、左侧下位9例、右侧上位2例、右侧下位11例。肿瘤最大径为（2.22±0.88） cm。24例患者中13例合并甲状腺病变。本组患者术后有8例出现手足、口周麻木，给予静脉或口服补钙后缓解，其余患者均无自觉症状。术后血钙及甲状旁腺激素均有不同程度下降，术后2周均降至正常范围。结论 甲状旁腺腺瘤所致无症状PHPT临床症状不典型，血清钙和甲状旁腺激素同步升高即可诊断，具有手术指征的患者应积极手术治疗。
ObjectiveTo analyze the relevant factors of levelⅡlymph node metastasis in papillary thyroid carci-noma. MethodsThe clinicopathologic data of 83 patients from November 2011 to March 2014 were analyzed retrospec-tively. All the primary tumors were papillary thyroid carcinoma located in unilateral lobe with ipsilateral lateral neck lymph node metastasis. The relationship of gender, age, microcarcinoma, superior pole involved by carcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis was analyzed. The calculated data were analyzed with Chi-Square test and there was significant difference when P < 0.05. ResultsThe rate of lymph node metastasis at levelⅡ, Ⅲ, Ⅳ, Ⅴ, Ⅵwas 51.8% (43/83), 78.3% (65/83), 71.7% (59/83), 4.8% (4/56), and 79.5% (66/83), respectively. There was no significant relationship of gender, age, microcarcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis (P > 0.05). The rate of lymph node metastasis at levelⅡwas significantly higher when superior pole involved by carcinoma (P < 0.05). ConclusionAmong the patients with papillary thyroid carcinoma, when superior pole involved by carcinoma the patient should be underwent selective neck dissection, the proper extent of dissection including levelⅡshould be performed.