Thirty patients with heperthyroidism were investigated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyromicrosome antibody (TMA), thyroglobulin antibody (TGA) and hydrocortisone before and after operation. The levels of serum T3, T4, TGA, TMA were markedly decreased after operation, and the level of hydrocortisone farther decreased from the preoperative low level. But only a little decrease in TSH level was found as compared with that before operation. The assay of these hormones and antibodies has very important clinical significance for judgement of the effect of operation and prevention of crisis of hyperthyroidism.
ObjectiveTo investigate the effectiveness of probe-based near infrared autofluorescence (AF) technology in the identification and functional protection of parathyroid gland (PG) during endoscopic total thyroidectomy. MethodsWe retrospectively collected the clinical data of 160 patients who underwent total thyroidectomy with bilateral central compartment lymph node dissection due to papillary thyroid carcinoma in Chongqing General Hospital from 1 July 2023 to 31 January 2024. Among them, 80 patients who used probe-based near infrared AF technology to identify the PGs were categorized as the AF group, 80 patients who used naked eye (NE) to identify the PGs were categorized as the NE group. The number of PGs identified, inadvertently removed, preserved in situ and autotransplanted, the incidence of postoperative hypoparathyroidism, and operative time were compared between the two groups. ResultsThe incidence of transient hypoparathyroidism was significantly lower in the AF group than that of the NE group [21.25% (17/80) vs. 43.75% (35/80), χ2=9.231, P=0.002], with no cases of permanent hypoparathyroidism in either group. The AF group had significantly more PGs identified and preserved in situ than the NE group (P<0.05) , but had significantly fewer PGs inadvertently removed and autotransplanted than the NE group (P<0.05). The AF group identified the first PG earlier than the NE group (4 min vs. 5 min, P<0.001). But there was no statistically difference in the operative time between the two groups (90 min vs. 94 min, P=0.052). ConclusionThe probe-based near infrared AF technology can help surgeons better identify and protect PGs during surgery, reducing the incidence of postoperative transient hypoparathyroidism.
ObjectiveTo summarize the development status, hot spots, and trends of radical thyroidectomy for thyroid cancer in recent 10 years by analyzing the data and atlas of the literatures related to radical thyroidectomy.MethodsLiteratures statistics and analysis technique of CiteSpace5.1 software were used to analyze the literatures related to radical resection of thyroid cancer, which were collected in CNKI database from January 1, 2008 to December 30, 2017, in order to obtain the trend of annual publication volume change, author and keyword clustering, and co-occurrence.ResultsFor the annual volume of articles, 148 articles were published from 2014 to 2017, with the authors clustering to6 groups with frequent frequency. Most of the authors were independent authors. The study focused on differentiated thyroid carcinoma, lymph node dissection and endoscopic surgery, recurrent laryngeal nerve injury, postoperative infection, decreased blood calcium, perioperative nursing, and preemptive analgesia. There were 35 keywords with order ≥ 6times, 8 keywords in cluster series, and 13 prominent words in the period from 2008 to 2017.ConclusionsThe literature of radical thyroidectomy developed rapidly from 2014 to 2017. Conducting horizontal joint research, cross-sectoral, cross-disciplinary research, and molecular diagnosis research are the deficiency of current research, and it should become the trend of research development.
Thyroid disease is more common in young women. Traditional surgical scars may affect the appearance of patients and cannot fully meet the cosmetic needs of patients. With the advancement of surgical techniques, endoscopic thyroid surgery has developed rapidly. Trans oral endoscopic thyroidectomy vestibular approach is feasible and safe to achieve no scar on the body surface, but there are some unavoidable limitations, such as postoperative numbness and discomfort in the center of the chin region. As a new approach to thyroid surgery, trans oral endoscopic thyroidectomy submental access has the same advantages as the trans oral vestibular approach from top to bottom, and can reliably and thoroughly dissect lymph nodes in the central area (especially area Ⅶ), allowing larger specimens to be taken out and expands the indications for surgery, minimizes flap detachment, and avoids jaw pain and numbness. Trans oral endoscopic thyroidectomy submental access is an innovation in the concept of thyroid surgery, which achieves minimally invasive and aesthetic results on the premise of ensuring the quality of the surgery and curing the disease. We reviewed the history, advantages and disadvantages of trans oral endoscopic thyroidectomy submental access.
Objective To explore complications of endoscopic thyroidectomy and conventional thyroidectomy and to analyze causes of them in order to reducing complications of endoscopic thyroidectomy. Methods A total of 1 112 patients with thyroid diseases from September 2008 to March 2017 in the Shanghai Tongren Hospital were collected, then were designed to endoscopic thyroidectomy group and conventional thyroidectomy group. The recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, tracheoesophageal injury, poor healing of surgical wound, skin ecchymosis and subcutaneous effusion, neck discomfort, and CO2 related complications were observed. Results ① There were 582 cases in the endoscopic thyroidectomy group and 530 cases in the conventional thyroidectomy group, the baselines such as the gender, age, most diameter of tumor, diseases type, operative mode, operative time, and intraoperative bleeding had no significant differences between the endoscopic thyroidectomy group and the conventional thyroidectomy group (P>0.05). ② All the operations were performed successfully, none of patients was converted to the open operation. The rates of the recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, and tracheoesophageal injury had no significant differences in these two groups (P>0.05). The rates of the poor healing of surgical wound and neck discomfort were significantly lower and the rate of the skin ecchymosis and subcutaneous effusion was significantly higher in the endoscopic thyroidectomy group as compared with the conventional thyroidectomy group (P<0.05). There were 32 cases of CO2 related complications in the endoscopic thyroidectomy group. Conclusion Results of this study show that endoscopic thyroidectomy is safe for thyroid diseases, it’s complications could be reduced by improving operation technique.
ObjectiveTo systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and conventional open thyroidectomy (COT) in the treatment of differentiated thyroid cancer.MethodsThe clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed, Embase, Cochrane Library, Wanfang, and CNKI by computer. The search date ended on March 1, 2020. Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.ResultsA total of 7 studies including 1 465 patients were included in this meta-analysis. The results showed: compared with the COT group, the operation time of the TOETVA group was longer [WMD=35.18, P=0.000 1], and the number of lymph node dissections in the central area was larger [WMD=1.42, P=0.000 5]. But the intraoperative blood loss [WMD=–5.32, P=0.39], the length of hospital stay after operation [WMD=0.05, P=0.94], the incidences of transient recurrent laryngeal nerve palsy [OR=0.81, P=0.43], transient hypocalcemia [OR=0.55, P=0.35], permanent hypocalcemia [OR=0.39, P=0.22], permanent recurrent laryngeal nerve palsy [OR=1.34, P=0.73], and hematoma [OR=1.29, P=0.69] were not statistically significant between the two groups.ConclusionsTOETVA has a higher stability. Although the COT has a shorter operation time, the former has a higher central lymph node dissection rate, and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
ObjectiveTo investigate the feasibility of dissecting the external branch of the superior laryngeal nerve using endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring. MethodsThe clinical data of 30 patients who underwent the gasless nilateral subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from October 2023 to February 2024 were retrospectively analyzed. ResultsAll operations were successfully completed under endoscopy approach without transfer to open surgery. A total of 29 cases of the external branch of superior laryngeal nerves were revealed in 30 cases, the revealed rate was 96.7%. The time for dissecting the external branch of the superior laryngeal nerve was 2–6 min [(3.6±2.3) min]. There was no obvious sound change related to the injury of the external branch of superior laryngeal nerve in postoperative patients. ConclusionFor the modified endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring, excellent anatomical protection of the external branch of the superior laryngeal nerve can be obtained.
Objective To explore the protection of the structure and function around the upper pole of the thyroid gland by endoscopic thyroidectomy combined with nerve detection through the gasless unilateral axillary approach. Methods From January 2019 to June 2020, 48 thyroid patients who underwent the gasless unilateral axillary approach combined with the endoscopy and nerve detection technology in the Department of Head and Neck Surgery of Zhejiang Provincial People’s Hospital were reviewed as the endoscopic group, and 53 thyroid patients underwent open surgery combined with the endoscopy and nerve detection technology as the open group. The protection of the functional structure of the suprathyroid pole were compared. Results In terms of operation time, the endoscopic group was longer than that of the open group (67.5 min vs. 54.1 min, P=0.001). There was no statistical difference between the two groups in terms of postoperative hospital stay and blood loss (P>0.05). Forty-seven patients with the endoscopic thyroid surgery through the gasless unilateral axillary approach effectively detected the superior laryngeal nerve (47/48, 97.9%), which was higher than that of the open group (40/53, 75.5%), P=0.003, and the exposure rate of hypoglossal nerve descending branch in the endoscopic group was also higher [31.3% (15/48) vs. 3.8% (2/53), P=0.001]. In the endoscopic group, the superior parathyroid gland was kept in situ during the operation, and there was no change of voice and cough after the operation. In the open group, there were 2 cases of autologous transplantation of the upper pole parathyroid gland, 2 patients had voice changes, and 1 case had partial upper pole banded muscle incision. There was no significant difference in the incidence of nerve injury complications, the rate of autologous transplantation of the upper pole parathyroid gland and the rate of anterior cervical banded muscle injury between the two groups (P>0.05). In addition, there was no significant difference in the levels of parathyroid hormone, blood calcium, blood magnesium and blood phosphorus between the two groups before/after operation (P>0.05). Conclusion During the endoscopic thyroidectomy through the gasless unilateral axillary approach, the nerve monitoring technology is combined with the exploration and protection of the superior laryngeal nerve on the surface of the medial cricothyroid muscle of the upper pole of the thyroid, and the fine capsule anatomy technology is used to protect the superior parathyroid gland in situ, which can more effectively expose the external branch of the superior laryngeal nerve. It is conducive to the protection of the structures around the upper pole.
Hypothyroidism is one of the focuses of attention in the field of thyroid surgery, but postoperative hypoparathyroidism has always been an unavoidable complication for surgeons. Currently, there is still controversy over the definition and classification of postoperative hypoparathyroidism, and there are significant differences in the definition and incidence of permanent hypoparathyroidism among different studies. The author provides preliminary suggestions and ideas for the diagnosis and definition of hypoparathyroidism based on relevant guidelines, literature, and clinical experience, in order to provide more accurate diagnosis and treatment plans for postoperative hypoparathyroidism.