Objective To investigate the anatomical character and variation of non-recurrent laryngeal nerve （NRLN）， and to explore measurement to identify and prevent injury of this nerve during thyroidectomy. Methods Clinical data of 2 211 patients who underwent thyroidectomy from Jan. 2007 to Jun. 2012 in Peking Union Medical College Hospital were analyzed retrospectively， and 114 patients with NRLN of related literature reviews were analyzed too. Results There were 3 479 recurrent laryngeal nerve （2 211 cases） which were exposed during thyroid operation in Peking Union Medical College Hospital， of which 11 cases were confirmed to be right NRLN （0.32%， 11/3 479）. Of the 11 cases， 3 cases were typeⅠ， 7 cases were typeⅡA， and 1 case was typeⅡB， one case was also found to have a recurrent branch. None of them injured during operation. One hundred and fourteen cases of NRLN （0.14%-4%） were found in literature reviews. Of the 114 cases， 109 cases were confirmed to be right NRLN， of which 4 cases were typeⅠ （3.7%， 4/109）， 75 cases were typeⅡA （68.8%， 75/109）， 9 cases were typeⅡB （8.3%， 9/109）， 21 cases were unclear （19.3%， 21/109）， 3 cases were also found to have a recurrent branch （2.8%，3/109）. Five cases were confirmed to be left NRLN， of which 2 cases were typeⅡA， 3 cases were unclear， 1 case was also found to have a recurrent branch. Of all the 104 cases reported by treatises and case reports， 16 cases injured during operation， of which 1 case was typeⅠ， 9 cases were typeⅡA， 6 cases were unclear. Conclusions NRLN， which is a rare anomaly， usually happens on the right， and very vulnerable during thyroid surgery. The most usually injured type is typeⅡA. Fully acknowledgment of the NRLN and its variant types is very helpful to avoid damage during thyroid surgery.
Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve （RLN） by meticulous capsular dissection and exposure of RLN in thyroid lobectomy. Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan. 2010 to Dec. 2012 were retrospectively analyzed. Results All of the 452 cases underwent thyroid lebectomy successfully without death， and the operative time was 45-110min （average 60 min）， the blood loss was 5-100mL （average 20mL）. The pathological results showed that there were thyroid adenoma in 193 cases， nodular goiter in 175 cases， Hashimoto thyroiditis in 38 cases， thyroid cancer in 46 cases. After operation， 4 cases suffered RLN injury， 1 of the 4 cases recovered after removal of drainage tube， and other 3 cases recovered during 0.5 to 3.0 months. In addition， 2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week， 5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment. Three cases were reoperated because of bleeding， including branch of anterior venous bleeding in 1 case， thyroid side arterial tube bleeding in 1 case， and thyroid stump bleeding in 1 case. Twenty one cases suffered hypothyroidism in 1 month after operation， and no recurrence happened during the followed up period. Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN. Exposure of RLN is safe and feasible， which plays an important role in avoiding serious RLN injury.
ObjectiveTo investigate the clinical value of cervical vascular color Doppler ultrasound for dignosis of nonrecurrent laryngeal nerve before thyroid surgery. MethodsThere were 1931 cases of thyroid patients treated between January 2010 to Jule 2014, group these patients according to the results of preoperative chest radiograph examination, the chest radiograph shows abnormal vessels image were group A (45 cases), no abnormalities were group B (1886 cases). Before operaton, made patients of group A to have routine carotid duplex ultrasound to identify whether the right subclavian artery abnormalities. All patients were exposed to conventional methods of recurrent laryngeal nerve during surgery. ResultsThe 45 patients of group A, chest angiography showed 17 cases with right subclavian artery abnormalities, they were confirmed that all the 17 patients were nonrecurrent laryngeal nerve by surgery, no damage cases. The other 28 cases showed a normal right subclavian artery and no cases of nonrecurrent laryngeal nerve. The 1886 patients in group B, surgical exploration found four cases with nonrecurrent laryngeal nerve, injury in 1 case. The 21 patients whose nonrecurrent laryngeal nerve were on the right side, there were no left side with nonrecurrent laryngeal nerve and no co-exist cases of nonrecurrent and recurrent laryngeal nerve. The average exposure time of nonrecurrent laryngeal nerve in patients of group A (17 cases) was significantly shorter than that group B[(4.28±1.08) min vs. (15.50±2.08) min, t=-15.978, P=0.000]. ConclusionsThe cervical vascular color Doppler ultrasound examination before thyroid surgery can be adjuvant used, if there is the right subclavian artery abnormalities, it showes that there is the right side nonrecurrent laryngeal nerve. So as to effectively prevent the damage of nonrecurrent laryngeal nerve during thyroid surgery.
ObjectiveTo discuss whether central lymph node dissection (CLND) should be performed for papillary thyroid cancer (PTC) patients. MethodsThe related domestic and foreign literatures were retrieved, the necessity of CLND and the risk of recurrent laryngeal nerve (RLN) injury in CLND were reviewed, and the application value of intraoperative nerve monitoring (IONM) in CLND were analyzed. Results① CLND can reduce the recurrence rate of PTC, improve postoperative survival rate, ease the difficulty of reoperation, and help to clarify tumor stage. ② CLND can increase the risk of RLN injury. ③ Application of INOM can decrease the risk of RLN injury. ConclusionsThe application of IONM during CLND effectively decrease the risk of RLN injury for surgeons, especially low seniority surgeons, and improve the survival quality and the prognosis. This combination will promote the implementation of routine CLND therapeutic strategy in thyroid cancer patients.
Objective To explore anatomical features and variation of non-recurrent laryngeal nerve and to summarize identification method, operation skill, and damage treatment experience of it. Method The clinical data of 15 patients with non-recurrent laryngeal nerve in 4 054 patients who underwent thyroidectomy from our division by the same medical group from January 2006 to January 2016 were retrospectively analyzed. Results A total of 6 626 recurrent laryngeal nerve (left side 3 248, right side 3 378) were exposed in 4 054 cases. Fifteen patients with non-recurrent laryngeal nerve were detected with an incidence of 0.23% (15/6 626), all located on the right side. There were 3 males and 12 females. There were 3 cases of type Ⅰ, 10 cases of type Ⅱa, 2 cases of type Ⅱb. And 2 patients with non-recurrent laryngeal nerve were injured. Conclusions Incidence of non-recurrent laryngeal nerve is lower, most of which occur on right side of neck, there is a high injury rate for its special anatomical location. It’s key to prevent nerve injury for careful interpreting preoperative auxiliary examination results and improving awareness of non-recurrent laryngeal nerve, fining dissection, conventional exposuring recurrent laryngeal nerve, and accurate using nerve monitor during operation.
Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.
ObjectiveTo investigate the predictive value of recurrent laryngeal nerve lymph nodes (RLN) status for supraclavicular lymph node (SLN) metastasis in esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical data of 83 patients with esophageal squamous cell carcinoma who underwent McKeown three-field lymphadenectomy from January 2017 to April 2018 in our hospital, including 53 males and 30 females with an average age of 64.07±7.05 years.ResultsThe SLN metastasis rate of the patients was 24.1%. The rate in the thoracic and abdominal metastases positive (N1-3) group and negative (N0) group was 37.8% and 13.0%, respectively, with a statistical difference (P<0.05). The rate of SLN metastasis was significantly different between the RLN metastasis positive (RLN+) and negative (RLN–) groups (39.1% vs. 18.3%, P<0.05). One side of RLN metastasis could lead to SLN metastasis on the opposite side. No correlation between the SLN metastasis and age, gender, location, differentiation degree, maximum tumor diameter, T-staging or histologic type was observed (P>0.05). Multivariate analysis showed that lymph node metastasis in chest or abdomen was an independent predictor of SLN metastasis.ConclusionRLN+ is not the independent predictor for SLN metastasis. SLN should be dissected in N1-3 patients with esophageal squamous cell carcinoma without considering tumor location and T-staging. Bilateral SLN dissection should be recommended even if RLN metastasis is only unilateral.
ObjectiveTo evaluate the safety and necessity of recurrent laryngeal lymph node resection by comparing the complications and prognosis of patients with recurrent laryngeal nerve injury receiving different recurrent laryngeal lymph node resections.MethodsWe reviewed the clinical data of 153 patients with stage T1N0M0 esophageal squamous cell carcinoma who underwent radical esophageal cancer surgery at the Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2014 to May 2016. Among them, 125 were male and 28 were female, at an average age of 62 years. All patients underwent bilateral recurrent laryngeal nodes sampling. They were divided into 3 groups according to the dissection situation: patients with only one recurrent laryngeal lymph node resection on both sides during the operation were treated as a sampling group (n=49); patients with only one recurrent laryngeal lymph node resection on one side and more than one recurrent laryngeal lymph nodes resection on the other side were treated as a unilateral dissection group (n=49); patients with more than one recurrent laryngeal lymph nodes resection on both sides were treated as a bilateral dissection group (n=55). Follow-up was performed to compare the prognostic differences among the three groups. Seven days after the operation, the vocal cords of the patients were examined with an electronic laryngoscope and classified using the Clavien-Dindo system. The differences in complications related to recurrent laryngeal nerve injury among the three groups were compared.ResultsThe 5-year overall survival (OS) rate of the patients in the sampling group, unilateral dissection group and bilateral dissection group was 66.8%, 88.5%, 93.8%, respectively. There was statistical difference between the sampling group and the unilateral dissection group or the bilateral dissection group (P<0.05), and no statistical difference between the unilateral dissection group and the bilateral dissection group (P>0.05). The incidence of complications among the three groups was not statistically different (P>0.05).ConclusionFor patients with esophageal squamous cell carcinoma of stage T1N0M0, the lymph nodes of the bilateral recurrent laryngeal nerves should be removed during the operation as many as possible, which will help improve the 5-year survival rate of the patients.
ObjectiveTo investigate the diagnostic value and the best criteria of multiplanar reconstruction (MPR) of spiral CT in recurrent laryngeal nerve lymph node metastasis.MethodsWe performed multiplanar reconstruction of the spiral CT data of 138 esophageal carcinoma patients admitted to our hospital between December 2016 and June 2019, including 113 males and 25 females with an average age of 47-85 (63.03±15.58) years. The short and long diameters of recurrent laryngeal nerve lymph nodes were measured respectively, and then ratio of short to long diameter was calculated. The three parameters were contrasted with the pathological results and the receiver operating characteristic (ROC) curves for the parameters were drawn.ResultsOf the 138 patients, 291 left recurrent laryngeal nerve lymph nodes were dissected with an average number of 0-14 (2.11±0.41) per patient and the metastasis rate was 16.70%; while 436 right ones were dissected with the average number of 0-17 (3.16±0.45) per patient and the metastasis rate was 21.00%. The total metastasis rate was 29.70%. In the diagnosis of lymph node metastasis, the areas under ROC curve for short and long diameters as well as the ratio of short to long diameter of left recurrent laryngeal nerve lymph nodes were 0.808, 0.779, 0.621, respectively, while those for the right ones were 0.865, 0.807, 0.637, respectively.ConclusionThe metastasis rate of recurrent laryngeal nerve lymph nodes is high and the short diameter has a higher diagnostic value for recurrent laryngeal nerve lymph node metastasis.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.