Objective To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.Methods One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.Results There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.Conclusions The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.
ObjectiveTo explore the safety-related factors for total thyroidectomy in differentiated thyroid carcinoma. MethodsThe clinical data of 72 patients with differentiated thyroid carcinoma treated by total thyroidectomy from January 2002 to January 2010 were retrospectively analyzed, the laryngeal recurrent nerve injury and hypoparathyroidism were observed. ResultsThe incidences of hypoparathyroidism and laryngeal recurrent nerve injury were 15.28% （11/72) and 4.17%（3/72）, respectively. The hypoparathyroidism was significantly related to the thyroid reoperation, the lymph nodes metastases of central compartment, or the extraglandular invasion of the primary tumor (Plt;0.05), but not to the dissection of neck lymph nodes (Pgt;0.05). The laryngeal recurrent nerve injury was not relative to those factors (Pgt;0.05). ConclusionThe safetyrelated factors of total thyroidectomy in differentiated thyroid carcinoma include thyroid reoperation, the lymph node metastasis of central compartment, and the extraglandular invasion of the primary tumor.
【Abstract】ObjectiveTo investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. MethodsThe parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginateBaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5，15，25，35，45，55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. ResultsThe calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. ConclusionMicroencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.
ObjectiveTo evaluate whether strategic parathyroid autotransplantation can decrease the incidence of hypoparathyroidism after central lymph node re-dissection in patients with papillary thyroid carcinoma. MethodsData were retrospectively collected from the patients with papillary thyroid carcinoma, who had undergone unilateral or bilateral central lymph node re-dissection in the Department of Thyroid Surgery, West China Hospital of Sichuan University between January 2009 and October 2015. The patients were divided into transplantation group and non-transplantation group according to the history of strategic parathyroid autotransplantation in the primary surgery. Data concerning patient demographics (age, sex, comorbidities, the leval of Ca2+ and parathyroid hormone, previous surgical manners and complications before reoperation), surgical manners of reoperation, and postoperative factors (laboratory examination and postoperative complications) were collected. ResultsA total of 74 patients, 35 in the transplantation group and 39 in the non-transplantation group, were included in the study. Significantly higher levels of Ca2+ and parathyroid hormone were observed in the transplantation group than in the non-transplantation group on one day after surgery (P < 0.05). Recurrent laryngeal nerve injury newly occurred in 2 patients in the transplantation group and 5 patients in the non-transplantation group, respectively (5.7% vs. 12.8%, P > 0.05). Transient hypoparathyroidism was documented in 4 patients in the transplantation group and in 12 patients in the non-transplantation group. Permanent hypoparathyroidism was documented in 1 patient in the transplantation group and in 4 patients in the non-transplantation group. The incidence of hypoparathyroidism was significantly lower in the transplantation group compared with the non-transplantation group (5 vs. 16, P < 0.05). The mean number of central lymph node identified pathologically was significantly more in the transplantation group (2.1±1.3 vs. 1.4±0.7, P < 0.05). ConclusionStrategic parathyroid autotransplantation can effectively decrease the incidence of hyperparathyroidism after central lymph node re-dissection in patients with papillary thyroid carcinoma, which greatly improves the surgical safety and thoroughness.
ObjectiveTo establish a stable laboratory model of temporary hypoparathyroidism following thyroid operation in rabbits. MethodsTwenty New Zealand white rabbits were randomized into 2 groups (the four parathyroid glands injured group and the two inferior parathyroid glands injured group, n=10 for each group). In the two inferior parathyroid glands injured group, blood supply vessels of the two inferior parathyroid glands were injured with ligation. In the four parathyroid glands injured group, total thyroidectomy (including two superior parathyroid glands) were performed and blood supply vessels of the two inferior parathyroid glands were injured with ligation. The number of the identified parathyroid glands were counted during operation. Serum calcium and parathyroid hormone (PTH) were evaluated preoperatively and postoperatively on 1 d, 2 d, 3 d, 5 d and in 1 week, 2 weeks, 3 weeks, and 4 weeks. Model achievement rate were calculated. ResultsFour parathyroid glands were identified in rabbits. The two superior parathyroid glands were in thyroid tissue which were identified with histology, and the two inferior parathyroid glands located in the fascia plane between the sternohyoid, sternothyroid muscles and the carotid artery which can easily be identified with naked eye. There were no significant difference in preoperative calcium and PTH between the two groups (P > 0.05). In the two inferior parathyroid glands injured group, significantly decreased in serum calcium were observed on 1 d, 2 d and 3 d after operation (P < 0.05). In the four parathyroid glands injured group, significantly decreased in blood calcium were observed on 1 d, 2 d, 3 d and 5 d after operation (P < 0.05). The lowest level of serum calcium was observed on 1 d in two groups. Postoperative serum PTH were significantly declined in two groups on 1 d, 2 d, 3 d, 5 d, and in 1 week, 2 weeks and 3 weeks (P < 0.05). The lowest serum PTH was also observed on 1 d in two groups. Significantly lower serum PTH were found in the four parathyroid glands injured group on 1 d, 2 d and 3 d than in the two inferior parathyroid glands injured group (P < 0.05). Lower PTH level were found in the four parathyroid glands injured group on 5 d, and in 1 week, 2 weeks, 3 weeks and 4 weeks, but no significance (P > 0.05). Positive correlation between serum calcium and PTH were noticed (r=0.771, P=0.000). Model achievement rate were higher on 3 d and 5 d in the four parathyroid glands injured group than that of the two inferior parathyroid glands injured group (P < 0.05). ConclusionsStable animal model of temporary hypoparathyroidism following thyroidectomy can be established by total-thyroidectomy plus ligation the blood vessels of the two inferior parathyroid glands. This model can be used for further study.