Objective To evaluate the influencing factors for hypocalcemia after total thyroidectomy in thyroid carcinoma.Methods 650 patients with thyroid carcinoma undergoing total thyroidectomy from Jun.2009 to Dec.2011 were followed up and analyzed retrospectively.The relativity between persistent hypocalcemia and the following criteria were studied:age, sex, primary tumor stage, initial thyroid treatment, neck dissection cen-tral compartment dissection, inadvertent parathyroidectomy, and thyroid caspsular dissection.χ2test was used to analyze the statistical correlation between hypocalcemia after total thyroidectomy and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlation of clinical factors and hypocal-cemia after total thyroidectomy. Results Persistent hypocalcemia was found in 112 out of 650 patients (17.2%).Advanced stage(OR=2.121,95%CI 1.140-3.947,P=0.018),bilateral central compartment dis-section(OR=1.852,95% CI 1.199 -2.863,P =0.006),failure to use thyroid caspsular dissection(OR =2.307,95%CI 1.208-4.405,P=0.011)and IPE(OR=1.580,95%CI 1.029-2.427,P=0.037)were inde-pendent predictive factors for hypocalcemia after total thyroidectomy.Conclusions It has high incidence of persis-tent hypocalcemia in patients with andvanced-stage thyroid carcinoma after going total thyroidectomy.Thyroid caspsular dissection method, proper indications for bilateral central compartment dissection, and reducing IPE can help to reduce the incidence of persistent hypocalcemia and improve the life quality of patients after going thyroidectomy.

Background and purpose:In recent years, energy-based instruments have been widely used in today’s open surgeries. Harmonic Focus? (HF) and Ligasure Small Jaw? (LSJ) are both custom-made for thyroid open surgery. This study aimed to explore the effcacy and safety of HF and LSJ in open thyroidectomy.Methods:The data from patients who undertook total thyroidectomy with central neck dissection by the same surgeon during last year in this hospital were reviewed. HF was used in 100 patients, and LSJ was used in 104 patients. The effectiveness was appraised by comparing operation time and postoperative volume of drainage on the ifrst postoperative day. The safety was appraised by comparing the incidence of postoperative complications.Results:The results of the effectiveness:the average duration of operation was (95.8±18.0) min for HF group, and (97.8±19.1) min for LSJ group, there was no statistical signiifcance (P=0.363). Postoperative volume of drainage on the ifrst postoperative day was (35.2±20.3) mL for HF group, and (36.3±23.8) mL for LSJ group, there was no statistical signiifcance (P=0.977). One patient (1.0%) had temporary vocal cord paralysis in HF and one had postoperative hematoma (1.0%) in LSJ group. Temporary hypo-parathyroidism was detected in 18 patients (18.0%) of HF group, and 16 patients (15.4%) of LSJ group. The decline of parathyroid hormone during the ifrst postoperative day was (12.3±12.8) pg/mL in HF group, and (13.9±13.4) pg/mL in LSJ group. The decline of serum calcium was (0.20±0.13) mg/dL in HF group, and (0.20±0.16) mg/dL in LSJ group. There were all no statistical signiifcances (P>0.05).Conclusion:Both HF and LSJ are safe and effective in open thy-roidectomy without similar operative complications.

Objective To investigate the necessity of primary neurorrhaphy (direct end-to-end anastomosis) when the recurrent laryngeal nerve(RLN) is severed during thyroid surgery.Methods 15 patients who suffered from iaotmgenic unilateral complete RLN injury or whose unilateral RLN had to be sacrificed because of disease invasion had a primary repair of RLN by direct end-to-end anastomosis.In control group,26 patients who did not have a nerve repair were enrolled into this study.Subjective evaluation of aspiration and voice quality were based on patient reports and hearer reports for all patients.9 patients with neurorrhaphy and 12 patients without nerve repair were followed with videolaryngoscopic examination.Results 14 patients undergoing neurorrhaphy restored normal voice at 2-5 months postoperatively.Although there were no significant functional motion of the vocal fold,slight adductory movement of the affected arytenoid was found with good tension vocal cords and symmetric arytenoids of the glottis during phonation.Only 2 patients without nerve repair had nearly restored normal voice.The patients with hoarseness had stiff arytenoids and atrophic folds resulting in glottal gap.Conclusions Neurorrhaphy is a simple and effective method to restore the normal aspiration and voice quality of patients with unilateral complete recurrent laryngeal nerve injuries.

Objective To investigate the optimal methods of detecting micrometastasis of sentinel lymph node(SLN) in papillary thyroid carcinoma(PTC).Methods Data of 51 consecutive PTC patients without clinical evidence of cervical lymph node metastasis were analyzed.They were conducted with SLN localization with blue dye,technetium-labeled sulfur colloid or the combination of them from Aug.2007 to Sep.2010.55 SLNs from 18 cases were selected.No metastasis was found to these 55 SLNs by routine pathological section.The 55 SLNs were serially sectioned at a 50 μm interval and stained by both HE and immunohistochemistry for detecting micrometastasis.Results SLN was successfully identified in all the 51 cases,with SLN identification rate of 100％.Among the 18 cases without metastasis to SLN by routine pathological section,5 cases were found micrometastasis by step sectioning plus immunohistochemically stains.The false negative rate was reduced from 15.4％ by routine pathological section to 2.6％ by step sectioning plus immunohistochemically stains.Conclusion Cytokeratin immunohistochemistry on series sections is a reliable method in detecting SLN micrometastasis in PTC.

ObjectiveTo evaluate combined radioisotope and methylene blue dye method for identifying sentinel lymph node (SLN) for modified radical neck dissection of papillary thyroid carcinoma (PTC). MethodFifty-one consecutive PTC patients without clinical evidence of locoregional lymph node involvement were enrolled in the study between August 2007 and September 2010.5 h ( rangel.5 - 8 h) before the surgery,one single intratumoral injection of 74 MBq in a volume of 0.4 ml 99mTc -Dextran was administered under ultrasound guidance and 1％ methylene blue dye was injected into the parenchyma surrounding the primary tumor intraoperatively.Preoperative lymphoscintigraphy,intra-operative hand-held gamma probe detecting and blue dyed lymph node were used to identify the SLN.All SLNs were sent for frozen-section and the specimens of routine selective neck dissection were stained with haematoxylin and eosin (H&E). ResultsSLNs were identified in 48 of 51 cases (94.1％ ) with combination method.SLN identification rate were 66.7％by methylene blue dye method and 90.2％by radioisotope method respectively.Final pathologic examination revealed that 30 cases ( 58.8％ ),including 3 cases who had negative SLNs,had lateral neck occult lymph node metastasis.The rate of occult lymph node metastasis in level Ⅱ,level Ⅲ,level Ⅳ and level Ⅴ were 17.6％,52.9％,29.4％ and 0％.Thus,the sensitivity,specificity,accuracy, and positive and negative predictive values of SLN biopsy were 90％, 100％,94.1％,100％ and 87.5％,respectively. ConclusionsSLNB is feasible and safe,the findings correlate with lateral lymph node status.Therefore,SLN biopsy is a good method for estimating the status of lateral lymph node in patients with clinical negative lymph node papillary thyroid carcinoma.

OBJECTIVE: To compare the oncological and functional outcomes in patients undergoing supracricoid partial laryngectomy with other traditional partial laryngectomy. METHOD: One hundred and fourteen patients treated from 1992 to 2007 were selected from all laryngeal cancer patients undergo partial laryngectomy through random match method by tumour subsite, TNM stage and age. Among them, 58 were supraglottic cancers, 56 were glottic cancers. Patients were divided into supracricoid laryngectomy group and other partial laryngectomy group. Each group includes 57 cases. We compare the 3-year and 5-year actuarial survival, local control rate and decannulation rate between two groups. RESULT: The 3-year and 5-year actuarial survival estimate was 90% and 87% for supracricoid partial laryngectomy, 97% and 92% for other partial laryngectomy (P > 0.05); Local control rate estimate was 94.2% for supracricoid laryngectomy and 91% for other partial laryngectomy(P > 0.05); Decannulation rate was 98% for supracricoid laryngectomy and 89.5% for other partial laryngectomy(P>0. 05); The decannulation was ever lower in horizontal-vertical partial laryngectomy than supracricoid partial laryngectomy (75% versus 98%, P < 0.01). CONCLUSION Comparing with other partial laryngectomy, supracricoid partial laryngectomy seems to have higher decannulation rate and is a considerable choice for selected laryngeal cancer.
Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; surgery ; Case-Control Studies ; Female ; Humans ; Laryngeal Neoplasms ; mortality ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Prognosis ; Survival Rate ; Treatment Outcome

Objective To study the larynx preservation after resection of posterior hypopharygeal wall squamous cell carcinoma.Methods Retrospective review of 13 patients who underwent resection of posterior hypopharyngeal wall squamous cell carcinoma from October 2004 to May 2013.Of 13 patients,6 had T2 lesions and 7 had T3 lesions.Two underwent salvage surgery,2 with concurrent chemoradiotherapy before surgery,2 with no radiotherapy and other 7 with postoperative radiotherapy (55 Gy).Repair with flap was not required in 6 cases,and repair with free skin graft was performed in 1 case,submental flap for 1 case,supraclavicular artery flap for 1 case,radial forearm flaps for 3 cases,and anterolateral thigh flap for 1 case for laryngopharyngeal reconstruction.Results The 3 year over all survival rate and disease-specific survival rate were 51.6％.Surgical complications included 3 fistula,1 wound infection,and 1 wound effusion.The rate of decanulation was 100％,and all patients were with oral feeding.Conclusion Different flaps can be used to reconstruct a functional larynx after resection of posterior hypopharyngeal wall squamous cell carcinoma,patients having good quality of life.

Objective To investigate the surgical mode, recurrence and prognosis for patients with head and neck neurofibromas and explore their treatment strategies. Methods The clinicopathological features, operation mode, prognosis and neural function of 46 patients with head and neck neurofibroma were analyzed retrospectively, and 41 of the cases were followed up for 24?170 months ( median 74 months ) . Results Among the 41 followed?up patients, 26 patients were cured and 15 patients were not cured ( two died) . The cure rate of the neurofibromas with neurofibromatosis type 1 ( NF1 ) and the neurofibromas without NF1 were 42.9% and 85.0%, respectively (P=0.005). The cure rate of localized, aggressive, diffuse and beaded neurofibromas were 100.0%, 46.6%, 40.0% and 66.7%, respectively ( P=0.009) . The cure rate of radical resection ( including expanding excision and complete resection ) and partial resection were 73.5% and 14.3%, respectively ( P=0.011) . The cure rates of expanding excision and partial resection were 80.0% and 14.3% ( P=0.029) . The cure rates of complete resection and partial resection were 70.8%and 14.3%, respectively ( P=0.026) . However, the cure rates of expanding excision and complete resection were not significantly different (P=0.581).Multivariate Cox model analysis indicated that thoroughness of surgery was the independent risk factor for the prognosis for patients with head and neck neurofibromas. Conclusions Neurofibroma is a kind of aggressive benign tumors. Some neurofibromas have a high recurrence rate and low recovery rate, and some nerves are essay to be injured in the operation. Lots of factors impact on the prognosis and recovery of the neural function. Therefore, operation opportunity and mode should be carefully selected.

Objective To investigate the surgical mode, recurrence and prognosis for patients with head and neck neurofibromas and explore their treatment strategies. Methods The clinicopathological features, operation mode, prognosis and neural function of 46 patients with head and neck neurofibroma were analyzed retrospectively, and 41 of the cases were followed up for 24?170 months ( median 74 months ) . Results Among the 41 followed?up patients, 26 patients were cured and 15 patients were not cured ( two died) . The cure rate of the neurofibromas with neurofibromatosis type 1 ( NF1 ) and the neurofibromas without NF1 were 42.9% and 85.0%, respectively (P=0.005). The cure rate of localized, aggressive, diffuse and beaded neurofibromas were 100.0%, 46.6%, 40.0% and 66.7%, respectively ( P=0.009) . The cure rate of radical resection ( including expanding excision and complete resection ) and partial resection were 73.5% and 14.3%, respectively ( P=0.011) . The cure rates of expanding excision and partial resection were 80.0% and 14.3% ( P=0.029) . The cure rates of complete resection and partial resection were 70.8%and 14.3%, respectively ( P=0.026) . However, the cure rates of expanding excision and complete resection were not significantly different (P=0.581).Multivariate Cox model analysis indicated that thoroughness of surgery was the independent risk factor for the prognosis for patients with head and neck neurofibromas. Conclusions Neurofibroma is a kind of aggressive benign tumors. Some neurofibromas have a high recurrence rate and low recovery rate, and some nerves are essay to be injured in the operation. Lots of factors impact on the prognosis and recovery of the neural function. Therefore, operation opportunity and mode should be carefully selected.

Objective To study clinicopathologic factors related to central lymph node (CLN) metastasis in different subregions for unilateral papillary thyroid carcinoma (PTC) with clinical N0.Methods A total of 145 PTC cases with clinical N0 treated in the same group of the department of head and neck surgery,Cancer Hospital,Chinese Academy of Medical Science between Jan.2011 and Jan.2014 was analysed retrospectively.Clinicopathologic factors related to CLN metastasis in different subregions were analyzed,including sex,age,tumor size,extrathyroidal extension,and multifocal tumor.Results CLN metastases existed in 57.9％ (84/145) cases and the incidences of ipsilateral paratracheal,pretracheal,and prelaryngeal metastasis were 53.8％,24.1％ and 11.3％ respectively.Right paratracheal lymph node metastasis occurred in anterior (17/38,44.7％)and posterior(12/38,31.6％) to the recurrent laryngeal nerve.Multivariate analysis indicated that extrathyroidal extension(OR =4.49,95％ CI 1.80-11.20,P =0.001) and tumor size (OR =2.17,95％ CI 1.06-4.45,P =0.034) were independent risk factors for ipsilateral paratracheal CLN metastasis ;ipsilateral paratracheal CLN metastasis(OR =2.12,95％ CI 0.08-4.60,P =0.003) was an independent risk factor for pretracheal CLN metastasis.Conclusions A high risk of CLN metastasis especially ipsilateral paratracheal metastasis exists in DTC with clinical N0.Ipsilateral paratracheal,pretracheal and prelaryngeal CLN dissection should be conducted when maximum tumor diameter more than 1 cm or extrathyroidal extension.CLN anterior and posterior to the recurrent larygeal nerve should be removed simultaneously when the ipsilateral paratracheal CLN metastasis at right side.Total thyroidectomy and contralateral paratracheal CLN dissection should be conciderded in multifocal tumor.