Objective To evaluate different laryngeal recurrent nerve dissections in thyroidectomy for benign and malignant thyroid diseases. Methods The chnical data of 572 patients undergoing thyroideetomy with at least one side nerve exposure were retrospectively analyzed.Results Among 572 cases,a total of 652 nerves were exposed,among those 451 were by lateral exposure,144 by inferior exposure,57 by superior exposure.Two non-recurrent laryngeal nerves were found in 572 cases.There were 6 cases referred to our department for postthyroidectomy hoarseness undergoing reexploration and it Was found that the laryngeal recurrent nerve were legated in 3 cases and severed in the other 3 cases.In this series,among those suffering from postoperative hoarseness at our own hospital,there were 3 cases in which the nerve was invaded by the tumor and it was unable to dissect the nerve intact from the tumor,while the other 4 were cases referred to our hospital for incomplete thyroidectomy and undergoing a difficult extensive second operation.Conclusions The use of lateral、inferior and superior exposure of laryngeal recurrent nerve dissection can ensure the safety and integrity of the nerve.

Objective To evaluate the salvage surgery for papillary thyroid cancer patients with residual neck metastatic lymph nodes after thyroidectomy.Methods Clinical data of 97 patients undergoing salvage neck dissection between September 2007 to June 2010 were analyzed retrospectively.Results Among 97 patients,residual metastatic lymph nodes were found in 80 patients in lateroposterial neck,overall residual rate was 82.47％.Residual rate was 85.71％ in 56 patients who underwent initial lateroposterial neck dissection in other hospitals:100％ in 8 patients who underwent berry-picking; 93.33％ in 30 patients who underwent partial dissection; 66.67％ in 18 patients who underwent whole neck dissection.Residual rate was 78.05％ in 41 patients who did not undergo initial lateroposterial neck dissection.The number of dissected lymph nodes was 15-45,with an average of 23 nodes removed and 8.21 metastatic lymph nodes per case.Residual metastatic lymph nodes were found in 67 patients in central neck,overall residual rate was 82.47％,residual rate was 53.85％ in 13 patients who underwent initial central neck dissection,and 71.42％ in 84 patients who did not undergo initial central neck dissection.Conclusions Correct imaging diagnosis decreases cervical residual metastatic lymph nodes in patients with papillary thyroid cancer.Successful salvage operation lies in choosing correct mode of neck dissection and carrying out sufficient dissection.

Objective To evaluate radical resection for thyroid carcinoma in patients without lateral neck lymph node metastasis.Methods Clinical data of 132 thyroid carcinoma patients without lateral neck lymph node metastasis undergoing radical thyroidectomy were retrospectively analyzed.Results There were 35 male and 97 female patients.Age ranged from 18 to 62 years,median age was 34.2 years.All patients underwent ipsilateral lobectomy plus isthmectomy and Ⅵ level dissection.The rate of recurrent laryngeal nerve injury was 4.5% (6/132).Taking into account of tumor invaded nerve,the rate of dissection procedure caused injury was 1.6% (2/128).Conclusion Combination of ipsilateral lobectomy plus isthmectomy and Ⅵ level dissection constitutes radical thyroidectomy in papillocarcinoma of the thyroid gland without lateral neck lymph node metastasis,recurrent laryngeal nerve exposure is the key for this en bloc resection.

Objective:To study the correlation of thymidine phosphory la se(TP) expression with histological parameters and microvessel density(MVD) in t umor stroma of oral squamous cell carcinoma(OSCC).Methods:52 cas es of oral squamous cell carcinoma and 10 cases of normal oral mucosa were immun ohistochemically stained with a SP method by using monoclonal antibody of TP and FⅧ-RA.The correlation of TP expression with the clinical data and MVD in tumo r stroma was analyzed.Results: The expression of TP in oral squa mous cell carcinoma was much higher than that in normal oral mucosa (P0.05).There was a positive correlation between the TP expression an d MVD(P

Objective To evaluate the protection of parathyroid glands in bilateral papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection.Methods The clinical data of 78 patients undergoing total thyroidectomy and bilateral central compartment dissection between May 2013 and May 2014 were analyzed retrospectively.Results Among 78 patients,131 superior parathyroid glands were protected in situ,among those,112 parathyroid glands located at the level of inferior edge of parathyroid cartilage;19 parathyroid glands located in the superior 1/3 part of the back sides of the thyroid glands.All the superior parathyroid glands located in the superior and lateral-superior part of the 2 cm part down from the entrance of recurrent laryngeal nerve.A total of 110 inferior parathyroid glands were protected in situ,among those,57 glands located in the superior of inferior thyroid artery;24 glands located just on the surface of inferior thyroid artery;29 glands located below the superior of inferior thyroid artery.Three parathyroid glands were found in the dissected tissues and were implanted immediately.Seven parathyroid glands were found with post-operative pathologic examinations.During surgery,four parathyroid glands was found in 27 patients,three in 30 patients,two in 16 patients,and one in 5 patients.Conclusion For papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection,identification of parathyroid glands and protection of blood supply to glands are the most effective methods to prevent hypoparathyroidism.

Objective To analyze the expression,mutation and codon 72 polymorphism in the Chinese laryngeal squamous cell carcinoma patients and the relationship with HPV infection.Methods The paraffin-embedded tissue blocks from 64 pathological-diagnosed laryngeal squamous cell carcinoma patients were included in this study.PCR and direct sequencing were used to screen the mutations in TP53 gene and immunohistochemistry was used to evaluate the expressing profiles of p53 proteins.Functional analysis software online were used to analyze the function changes of mutated p53 proteins.The relationship between TP53 mutation and phenotypes of SNP72 with other features of the patients was analyzed by Chisquare and Fisher' s exact test.Results Out of 64 laryngeal squamous cell carcinoma patients,sequencing confirmed 30 TP53 mutations in 22 cases (73.3％) and p53 immunohistochemistry (IHC) confirmed 20 (31.3％) positive staining.Online software analysis showed that most of the mutated p53 proteins lost their normal function.Analyses of SNP72 polymorphism revealed that the patients with Arg phenotype had significantly older onset ages than those with Pro phenotype but without statistic difference.Conclusion TP53 mutations are frequently observed in Chinese patients with laryngeal squamous cell carcinoma and this is one of the pathogenesis for laryngeal squamous cell carcinoma.

Objective To analyze the PrP protein expression and the clinical degrees and pathological grade of head and neck squamous cell carcinomas.Methods Immunohistochemistry technique was used to test the PrP protein expression in the 92 head and neck squamous cell carcinomas cases.SPSS software was used to analyze the relationship between the PrP protein and the clinical degrees and pathological grade of head and neck squamous cell carcinomas.Results In the 92 head and neck squamous cell carcinomas cases,the positive rate of PrP protein was different with the sites of the carcinomas,the clinical degree and the pathological grade.Conclusion High expression of PrP protein related with the occurrence and development of head and neck squamous cell carcinomas.

Objective To study the risk factors for postoperative hypoparathyroidism or hypocalcemia.Methods Totally 414 patients with thyroid diseases who underwent total or near total thyroidectomy at Department of Head and Neck Surgery,Peking University Cancer Hospital and Institute from June 2007 to June 2014 were studied retrospectively.There were 119 male and 295 female patients with a median age of 47 years.The clinical and pathological features that related to post-operative hypoparathyroidism were studied by x2 test and multivariate Logistic regression analysis.Results Of the 414 patients,36.2％ developed transient hypocalcemia,36.5％ developed transient hypoparathyroidism,2.2％ developed permanent hypoparathyroidism.In regression analysis,unilateral or bilateral center lymph node dissection were associated with mild transient hypocalcemia after surgery (OR =2.366,P =0.022;OR =5.216,P =0.000);unilateral or bilateral center lymph node dissection as well as surgical options were significant risk factors for severe transient hypocalcemia (OR =4.029,P =0.001;OR =8.384,P =0.000;OR=2.073,P =0.017) and hypoparathyroidism (OR =1.755,P =0.040;OR =4.144,P =0.000;OR =2.287,P =0.000).The parathyroid hormone concentration on postoperative day 1 was an independent risk factor for permanent hypoparathyroidism (OR =2.011,P =0.014).The concentration of parathyroid hormone threshold ＜ 5.28 ng/L was a predictor to permanent hypoparathyroidism with accuracy of 95.0％.Conclusions Bilateral center lymph node dissection is a risk factor of permanent hypoparathyroidism in patients received total thyroidectomy should be taken thoughtfully.The parathyroid hormone concentration on postoperative day 1 provides better prediction for persistent hypoparathyroidism.

Objective To study the risk factors for postoperative hypoparathyroidism or hypocalcemia.Methods Totally 414 patients with thyroid diseases who underwent total or near total thyroidectomy at Department of Head and Neck Surgery,Peking University Cancer Hospital and Institute from June 2007 to June 2014 were studied retrospectively.There were 119 male and 295 female patients with a median age of 47 years.The clinical and pathological features that related to post-operative hypoparathyroidism were studied by x2 test and multivariate Logistic regression analysis.Results Of the 414 patients,36.2％ developed transient hypocalcemia,36.5％ developed transient hypoparathyroidism,2.2％ developed permanent hypoparathyroidism.In regression analysis,unilateral or bilateral center lymph node dissection were associated with mild transient hypocalcemia after surgery (OR =2.366,P =0.022;OR =5.216,P =0.000);unilateral or bilateral center lymph node dissection as well as surgical options were significant risk factors for severe transient hypocalcemia (OR =4.029,P =0.001;OR =8.384,P =0.000;OR=2.073,P =0.017) and hypoparathyroidism (OR =1.755,P =0.040;OR =4.144,P =0.000;OR =2.287,P =0.000).The parathyroid hormone concentration on postoperative day 1 was an independent risk factor for permanent hypoparathyroidism (OR =2.011,P =0.014).The concentration of parathyroid hormone threshold ＜ 5.28 ng/L was a predictor to permanent hypoparathyroidism with accuracy of 95.0％.Conclusions Bilateral center lymph node dissection is a risk factor of permanent hypoparathyroidism in patients received total thyroidectomy should be taken thoughtfully.The parathyroid hormone concentration on postoperative day 1 provides better prediction for persistent hypoparathyroidism.