Objective To explore the pattern and clinical influencing factors of cervical lymph node metastasis in papillary thyroid carcinoma （PTC）， and provide a basis for the choice of surgical approach for the PTC neck lymph node processing. Methods The clinical data of 98 patients with PTC treated in Affiliated Hospital of Guiyang Medical College from Jan. 2009 to Dec. 2011 were collected， and the pattern and clinical influencing factors of cervical lymph node metastasis were analyzed. Results Ninety eight consecutive patients underwent neck dissection in a total of 114 sides. The lymph node metastasis rate of cervical lymph node， districtⅥ， districtⅡ＋Ⅲ＋Ⅳ， and districtⅤwas 77.55% （76/98）， 74.49% （73/98）， 42.86% （42/98）， and 5.10% （5/98）， respectively. Results of univariate analysis showed that lymph node metastasis rates were higher in patients with diameter of tumor greater than 1 cm， tumor invaded thyroid capsule， multi-focal tumor， and old than 45 years （P＜0.05）. Results of multivariate analysis showed that the age of patients， diameter of tumor， tumor invaded thyroid capsule， and multifocal tumor were independent risk factors of cervical lymph node metastasis （P＜0.05）. Tumor invaded thyroid capsule， multifocal tumor， combined with districtⅥmetastasis， and combined with districtⅡ＋Ⅲ＋Ⅳ metastasis were independent risk factors of prelaryngeal lymph node metastasis （P＜0.05）. Tumor invaded thyroid capsule and multifocal tumor were independent risk factors of skip lymph node metastasis （P＜0.05）. Conclusions DistrictⅥ is found to be the predominant site for lymph node metastasis of PTC， the districtⅢ and the districtⅣinvolved in addition， so it is necessary to clean lymph nodes at districtⅥ routinely. The regularity of cervical lymph node metastasis can provide the basis for surgeon to choose a reasonable type of neck dissection.
ObjectiveTo evaluate the role of the treatment for chylous fistula after neck dissection with adhesive vacuum assisted washing and aspiration. MethodsFrom January 2004 to December 2010, 20 patients with chylous fistula after neck dissection treated with adhesive vacuum assisted washing and aspiration were reviewed. ResultsEighteen of 20 recovered in 10 to 12 days’ treatment without any complications. Drainage volume bagan to decrease noticeably in 5 days. Two patients needed reoperation and were discharged on day 15 and 17 respectively after operation. ConclusionThe treatment with adhesive vacuum assisted washing and aspiration is a safe and effective way for chylous fistula after neck dissection.
ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
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.
ObjectiveTo investigate the cause and treatment for chyle fistula after neck radical dissection using harmonic scalpel. MethodsFrom January 2005 to April 2009, 105 patients with thyroid carcinoma underwent thyroidectomy by harmonic scalpel (harmonic scalpel group) and 110 patients with thyroid carcinoma by conventional procedures (conventional group). Postoperative chyle fistula in all the cases was studied retrospectively. ResultsThe incidence of chyle fistula was 5.71% (6 of 105 patients) in the harmonic scalpel group and 0.91% (1 of 110 patients) in the conventional group. The difference was significant between two groups (Plt;0.05). ConclusionsHarmonic scalpel increases the risk of chyle fistula in neck radical dissection. The conventional procedures with exposing and preserving or ligating the thoracic duct can reduce the risk significantly.
颈淋巴结清扫术后乳糜漏是颈部外科手术后比较少见的并发症，国内、外文献［1-7］报道其发生率约为1%～3%，其原因很明确，即术中损伤胸导管或其分支。颈淋巴结清扫术后乳糜漏对生命有潜在威胁，且显著延长患者住院时间、增加医疗费用。尽管手术方法及手术器械不断改进，其发生率并没有明显降低，对于部分难治性乳糜漏目前还没有简单有效的办法。现就颈淋巴结清扫术后乳糜漏的预防及治疗方法介绍如下……
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.