Objective To study the anatomy,exposure and operation method in prevention of recurrent laryngeal nerve injury in thyroid surgery.Methods The clinical data of 520 patients with thyroid disease in treatment of operation were retrospectively analyzed,and exposure of recurrent laryngeal nerve in 268 cases,non exposure of recurrent laryngeal nerve in 252 cases; resection of the majority of thyroid in 232 cases,resection of ipsilateral thyroid lobe+ isthmus+on the side of most resection operation in 220 cases; resection of ipsilateral thyroid thyroidectomy+contralateral subtotal+ipsilateral lymph node dissection operation in 68 cases.Results Exposure of recurrent laryngeal nerve in 268 cases.The recurrent laryngeal nerve in the external laryngeal branch was single 214 cases,accounted for 79.9％ (214/268); two 42 cases,accounted for 15.7％ (42/268),more than 12 cases,accounted for 4.5％ (12/268).The laryngeal recurrent nerve during thyroid artery through the rear 143 cases,accounted for 53.4％(143/268) ; during thyroid artery through the front 92 cases,accounted for 34.3％ (92/268); walk line between thyroid artery branches 33 cases,accounted for 12.3％(33/268).The thyroid permanent damage rate of exposure of recurrent laryngeal nerve surgery was 1.1％(3/268),lower than that in non exposure of recurrent laryngeal nerve surgery 6.0％ (15/252) (P ＜ 0.05).The thyroid permanent damage rate between resection of the majority of thyroid and resection of ipsilateral thyroid lobe + isthmus + on the side of most resection operation had no significant difference (P ＞0.05),compared with the former two,resection of ipsilateral thyroid thyroidectomy + contralateral subtotal + ipsilateral lymph node dissection operation increased significantly (P ＜0.05).Exposure of.recurrent laryrngeal nerve in benign 173 cases,6 cases of thyroid transient damage,permanent damage in 1 case; 95 cases of malignant thyroid,6 cases of thyroid transient damage,permanent damage in 2 cases,the thyroid permanent damage rate in both had no significant difference (P ＞ 0.05).Conclusion Exposure of recurrent laryngeal nerve operation can significandy reduce the incidence of recurrent laryngeal nerve injury,for the partial thyroidectomy,can chose non exposure of recurrent laryngeal nerve operation method.

Objective To investigate the effect of neoadjuvant chemotherapy on gastric cancer based on FOLFOX7 or XELOX,so as to achieve evidence of clinical practice.Methods From January 2005 to June 2010,a retrospective analysis was performed for those patients with gastric cancer and underwent surgery.The patients were divided into neoadjuvant chemotherapy group and conventional chemotherapy group according to the chemotherapy method.The clinical efficacy,Ro resection rate and survival rate were evaluated in two groups.Results A total of 185 cases were included in neoadjuvant chemotherapy group (FOLFOX7 or XELOX,113 cases) and conventional chemotherapy group (72 cases).There was no significant difference in general status between two groups (P ＞ 0.05).Complete remission was in 48 cases,partial remission was in 51 cases,stable was in 14 cases,progression of disease was in 0 case in neoadjuvant chemotherapy group,and the effective rate was 87.6％ (99/113).Complete remission was in 30 cases,partial remission was in 25 cases,stable was in 15 cases,progression of disease was in 2 cases in conventional chemotherapy group,and the effective rate was 76.4％(55/72).There was significant difference in the effective rate between two groups (P＜ 0.05).The R0 resection rate in neoadjuvant chemotherapy group was higher than that in conventional chemotherapy group [60.2％ (68/113) vs.38.9％ (28/72)],and there was significant difference between two groups (P＜ 0.01).There was no significant difference in survival rate between two groups (P ＞ 0.05).Conclusion Neoadjuvant chemotherapy can reduce the tumor stage and improve the R0 resection rate,but has no obvious advantage in improving the survival rate during follow-up period.