Objective To explore the correlation factors and clinical significance of lymph node metastasis in right recurrent laryngeal nerve of thyroid papillary carcinoma (PTC).Methods Ninty-eight consecutive patients with PTC who were underwent total thyroidectomy with routine central lymph node dissection in the Second People's Hospital of Hefei from January 2015 to August 2017 were analyzed.The right paratracheal lymph nodes in the central compartment lymph nodes were divided into the level Ⅵ-A (anterior) and level Ⅵ-B (posterior,that was lymph node posterior to recurrent laryngeal nerve) compartments by recurrent laryngeal nerve.The lymph node metastasis of Ⅵ-B area during central compartment lymph node dissection was analyzed.We drew the receiver-operating characteristic curve (ROC) for right neck Ⅵ-A number of lymph node metastasis,and calculated the area under the curve (AUC) and Youden index.Results Among 98 cases,16 cases occurred Ⅵ-B district lymph node metastasis (16.33％).Single factor analysis results showed that lymph node metastasis in Ⅵ-B area of PTC patients were related to the tumor size (x2 =12.864,P ＜0.001),tumor capsular invasion (x2 =16.354,P ＜ 0.001),the right neck Ⅵ-A area lymph node metastasis (x2 =16.065,P ＜ 0.001),tumor number (x2 =15.593,P ＜ 0.001) and neck lymph node metastasis (x2 =21.098,P ＜0.001),but they were not related to the patients' gender,age and lesion location (all P ＞ 0.05).Lymph node metastasis in Ⅵ-B area of PTC patients were related to the number of right neck Ⅵ-A area lymph node metastasis.When the number of right neck Ⅵ-A metastatic lymph nodes was 2.5,the sensitivity and specificity were 70.60％ and 70.00％ respectively,AUC was 0.754,and Youden index was 0.406.Conclusion For patients with PTC,primary tumor diameter ＞ 1 cm,tumor extracapsular invasion,Ⅵ-A area lymph node metastasis,multiple tumor and lateral cervical lymph node metastasis were the predictive factors for the lymph node metastasis in Ⅵ-B area.When the number of right neck Ⅵ-A area metastatic lymph nodes was greater than 3,we should dissect Ⅵ-B area.

Struma ovarii is a highly specialized form of monoderal ovarian teratoma, in which thyroid tissue has exceeded all other tissues or only thyroid tissue malignant struma ovarii is a very rare disease. Studies have confirmed that the pathogenesis is basically consistent with primary thyroid cancer. Preoperative diagnosis is difficult and the diagnosis should be based on postoperative paraffin pathology. It’s important to emphasize that the histologic malignance does not represent malignant ovarian behavior. Transabdominal hysterectomy+bilateral salpingo-oophorectomy has a better prognosis, and there are different opinions on the management of the mainstream thyroid. Most patients take active thyroid excision followed by chemotherapy and radiotherapy and 131I for postoperative follow-up in accordance with the principle of primary thyroid cancer.

The pancreatojejunostomy is one of the most challenging steps in pancreatic reconstruction surgery,and its success directly impacts the patient's prognosis.The pancreas has characteristics such as being narrow at the top and wide at the bottom,fragile in texture,rich in digestive enzymes,and subject to constant intestinal peristalsis.These factors can easily lead to the loosening of the pancreatojejunostomy site and the occurrence of postoperative pancreatic fistula.Through mechanical modeling analysis and a summary of clinical practice,the authors propose a pancreatojejunostomy method based on mechanical principles.This method is summarized as"1-tube,2-needle,3-suture"method,which refers to one pancreatic duct stent tube,two types and two strands of different sutures,and three different suturing techniques.This article will provide a detailed introduction to this operative method and deeply analyze its technical principles.Additionally,a retrospective analysis of cases from the authors'center found that this method can effectively reduce the incidence of postoperative pancreatic fistula.

Objective To evaluate the intraoperative identification of ectopic parathyroid tissue in the central neck region using autofluorescence point-spectral analysis(AFPSA)combined with immune colloidal gold technique(ICGT),for guiding total parathyroidectomy(TPTX)or clean parathyroidectomy(CPTX)in the management of secondary hyperparathyroidism(SHPT).Methods Retrospectively collected and compared the clinical data of 64 patients with SHPT from October 2019 to June 2023.In the observation group,TPTX was performed as the initial procedure in 36 cases,followed by sampling of suspicious targets using AFPSA in the central neck area and subsequent detection through ICGT.CPTX was then conducted if a positive result was obtained.On the other hand,the control group consisted of 28 cases where only TPTX was performed without any additional tests during surgery.The surgical data,parathyroid hormone(PTH)levels,blood calcium levels,blood phosphorus levels,alkaline phosphatase(ALP)levels,regression of clinical symptoms,changes in parathyroid function and occurrence of hypocalcemia were compared between these two groups.Results In the observation group,there were 9 cases of AFPSA-ICGT positivity,including 2 left-sided cases,4 right-sided cases,and 3 thymic cases;among these posi-tive cases,there were a total of 10 locations with mildly hyperplastic or nonhyperplastic microscopic parathyroid tissue.The difference in the number of total parathyroid glands removed(including ectopic)between the two groups was statistically significant(P<0.05).At both 3 and 6 months postoperatively,ALP levels in the observation group were significantly lower than those in the control group(P<0.01 and P<0.001 respectively);at 6 months postoperatively,differences in PTH and blood phosphorus levels between the two groups were also statistically significant(P<0.05 and P<0.001 respectively).Joint bone pain and skin itching recurred in some patients within the control group at six months after surgery(P<0.05),whereas recurrence of SHPT was less frequent within the observation group compared to controls(P<0.05);however,no statistically significant differences were observed regarding postoperative hypoparathyroidism or hyperparathyroidism as well as hypocalcemia between either groups.Conclusion The AFPSA-ICGT intraoperative test can be utilized to guide surgery for SHPT,enabling accurate and efficient identification as well as safe targeting of parathyroid tissues that may not exhibit obvious hyperplasia in the central cervical region.