Objective To explore the clinical value of Delphian node (DN) metastasis in papillary thyroid cancer(PTC).Method In this study,86 cases of unilateral PTC proved by frozen pathology and initially undergoing surgical treatment were enrolled to evaluate Delphian nodes metastasis in its correlation with age,sex,tumor size,extra-thyroid extension and central and lateral compartment nodes.Results All patients underwent homolateral thyroidectomy plus contralateral subtotal thyroidectomy,central compartment and region Ⅲ and Ⅳ lymphadenectomy.There were no mortality and major morbidities.The following-up rate was 91.9％ (79/86).The mean following-up time was 45 months,and there was no tumor recurrence and metastasis.DN-postive was in close relation to extra-thyroid extension ( 60％ vs.24％ ;P =0.019)positive central compartment ( 80％ vs.27％ ;P ＜ 0.01 ) and lateral compartment lymph node metastasis (40％ vs.5％ ;P ＜ 0.01 ).DN-postive was also in close relation to the number of metastastic nodes ( average 7 vs.2 numbers of node;P =0.002 ) and the size of the node (2.1 cm vs.0.8 cm;P =0.02).Conclusions DN-postive has close relationship with extra-thyroid extension and central and lateral compartment nodes in PTC patients.

Objective To explore the rule of central region lymph nodes metastasis in differentiated thyroid carcinoma (DTC) and the significance of central region lymph nodes neck dissection in surgical operation for DTC.Methods The clinical and pathological data of 122 lymph nodes in 109 patients (31 female and 78 male) with DTC undergoing neck lymph nodes ( central region lymph nodes included) dissection from Jan.2003 to Jun.2007 in our hospital were analyzed retrospectively.According to preoperative physical examination and imaging analysis,patients were divided into clinical cervical lymph nodes metastasis ( cN + ) group and clinical no cervical lymph nodes metastasis (cNO) group and compared respectively with their pathological data after surgery.Resuits Of the 122 lymph nodes,lymph node metastasis rate was significantly higher in region Ⅵ than in region Ⅱ,Ⅲ and Ⅳ.The difference had statistical significance (P ＜0.01 ).65.6％ (80/122) metastasis was in the central region.81.2％ (56/69) patients in cN + group and 45.3％ (24/53) patients in cN0 group had central region lymph nodes metastasis.Conclusions Central region lymph nodes metastasis is common for patients with DTC.Routine neck dissection in central region should be done in DTC operation.

Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87％ ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.

Objective To discuss the prevention and treatment of the complications of modified radical mastectomy with nipple-areola complex (NAC) sparing. Methods The clinical data of 124 breast cancer patients who had a NAC sparing modified radical mastectomy from January 1998 to December 2008 were analyzed retrospectively. The causes of complications were evaluated and the proposal of prevention and treatment was put forward. Results Of the 124 patients, 18 had nipple necrosis (14.52%), 9 had skin infections and necrosis (7.26%), 7 subcutaneous hydrops(5.65%), 5 upper extremity lymphedema (4.03%), 3 chest muscle contracture with ipsilateral upper limb dyskinesia (2.42%), and 2 operative residual cavity hemorrhage(1.61%). Conclusion All the post-operative complications listed above could be possibly avoided by more careful operation procedure.

Objective To compare the effect of breast conserving surgery and modified radical mastectomy on the clinical efficacy of patients with early breast cancer.Methods CNKI,Chinese Journal Full-text Database (CJFD),China Biology Medicine Disc (CBMdisc),China Dissertation Database (Chinese Dissertation Database,CDDB) google academic and other databases were comprehensive searched.And then the search time was limited to between January 1,2015 and September 1,2017.Key words can be locked for breast conserving surgery,improved surgery for breast surgery,case-control studies,etc.,and then meet the conditions of the literature into the study,for a retrospective analysis.The authors reviewed the literature independently,extracted data and evaluated the risk of bias,and used Review Manager 5.3 software for systematic analysis.Results A total of 1 093 patients with early breast cancer were enrolled in the study.The Meta-analysis showed:there was a significant difference in operation time between the two groups(MD =-30.71,95％ CI:-31.96--29.46,P ＜ 0.01);there was a significant difference in intraoperative blood loss between the two groups(MD =-53.30,95％ CI:-55.38--51.22,P ＜ 0.01);there was a significant difference in postoperative hospital stay (MD =-5.66,95％CI:-7.17--5.17,P ＜0.01) and the incidence of complications (OR =0.30,95％ CI:0.19-0.47,P ＜ 0.01)compared with modified radical mastectomy in early breast cancer patients.There was no significant difference between the two groups in the postoperative recurrence and metastasis (OR =0.78,95％ CI:0.54-1.13,P =0.19).Conclusions In the choice of surgical methods,breast-conserving therapy is better than modified radical surgery,and postoperative recurrence and metastasis rate has no significant difference.