OBJECTIVE To explore emergency airway opening methods for patients with dyspnea caused by tumor related cervical tracheal stenosis,and summarize safe and effective emergency management methods for such patients.METHODS Retrospectively collect cases of dyspnea caused by tumor invasion or wrapping around the cervical trachea treated in the First Affiliated Hospital of Anhui Medical University between January 2012 and December 2023,analyze the process or method of emergency airway opening,and summarize the safe and effective airway opening methods for such patients.RESULTS A total of 31 cases were collected,including 25 cases of thyroid malignant tumors invading the cervical trachea(18 cases of differentiated thyroid cancer,5 cases of thyroid lymphoma,1 case of undifferentiated cancer,and 1 case of medullary cancer),3 cases of cervical tracheal recurrence after laryngeal cancer surgery,2 cases of primary tumors in the cervical trachea,1 case of cervical esophageal cancer,24 cases of grade II dyspnea upon admission,6 cases of grade III dyspnea,and 1 case of grade IV dyspnea.The methods of airway opening are as follows:20 cases underwent tumor resection and tracheotomy under anesthesia intubation and general anesthesia,6 cases underwent longitudinal downward tracheostomy with the larynx as the landmark,2 cases underwent midline tumor resection with the chin and sternum as the landmark to expose the trachea,2 cases underwent emergency tracheotomy with extracorporeal membrane oxygenation(ECMO)support,and 1 case underwent tracheotomy with extracorporeal circulation machine support.All patients successfully opened their airways without serious complications such as major bleeding,asphyxia,or cardiovascular and cerebrovascular accidents.CONCLUSION For patients with tumor induced cervical tracheal stenosis that is difficult to expose the trachea using conventional methods and requires emergency airway opening,the anesthesiology department can first evaluate whether a small tracheal tube can be inserted for general anesthesia before tracheotomy.If intubation is difficult,the airway can be opened by longitudinally splitting the cricoid cartilage or the anterior wall of the trachea,marked by the larynx.If the larynx is covered or wrapped by tumors and cannot be exposed,the midline marked by the chin and suprasternal fossa can be used to remove a portion of the tumor and expose the trachea,followed by longitudinally splitting the anterior wall of the trachea to open the airway.If the above methods are difficult to operate,it is feasible to remove the tumor under general anesthesia with extracorporeal circulation or ECMO support,expose the trachea,and open the airway.

Purpose To explore the relationship between regulatory T cells(Treg cells)and natural killer(NK)cells with tumor occurrence and development in papillary thyroid carcinoma(PTC).Methods Hematoxylin and eosin(HE)staining was performed on pathological tissue sections from patients with nodular goiter and PTC to evaluate im-mune cell infiltration.Flow cytometry was used to detect the percentage and absolute count of Treg cells and NK cells in peripheral blood from healthy controls(HCs)and PTC patients.Treg cells phenotypes(ICOS、PD-1、Lag3)and their IL-10 secretion ability were analayzed,along with functional molecules(TNF-α、IFN-γ、Granzyme B、Perforin)ex-pressed by NK cells.A cytometric bead array was used to measure serum cytokine IL-10 concentration.Changes in Treg and NK cells and their correlations were analyzed.Results Immune cell infiltration in PTC tissues is higher than in nodular goiter tissue.Compared with healthy controls,PTC patients exhibited a significant increase in the percentage[(6.86±3.10)％]and absolute count[(4.97±2.82 × 106 cells/mL)]of circulating Treg cells,with an enhanced IL-10 secretion capacity[(7.18±3.57)％],which is related to lymph node metastasis and vascular invasion.Con-versely,NK cell percentage[(16.56±8.44)％]and absolute count[(3.29±3.12 × 106 cells/mL)]were reduced,with impaired effector functions.The NK-to-Treg cell ratio(2.49±1.60)significantly declined,and a negative corre-lation was observed between the percentage of the two groups cell types(P=0.04,r=-0.625).Serum IL-10 levels in PTC patients were elevated[(1.30±1.09)pg/mL],correlating with tumor size and lymph node metastasis.After treatment with 1,25-(OH)2-D3,PTC patients showed a reduction in the percentage[(7.01±2.13)％]and absolute count(4.27±1.62 × 106 cells/mL)of circulating CD4+CD25+CD127low Treg cells,and a decrease in serum cytokine IL-10 levels[(1.27±0.09)pg/mL].Circulating NK cells percentages[(20.6±6.72)％]and absolute counts[(5.63±2.93)× 106 cells/mL]partially recovered.Conclusion PTC patients exhibit a pronounced immunosup-pressive state.Dysregulated numbers and functions of Treg and NK cells are closely associated with the occurrence,de-velopment,and prognosis of PTC,highlighting their potential importance in tumor immunotherapy.

Purpose To explore the relationship between regulatory T cells(Treg cells)and natural killer(NK)cells with tumor occurrence and development in papillary thyroid carcinoma(PTC).Methods Hematoxylin and eosin(HE)staining was performed on pathological tissue sections from patients with nodular goiter and PTC to evaluate im-mune cell infiltration.Flow cytometry was used to detect the percentage and absolute count of Treg cells and NK cells in peripheral blood from healthy controls(HCs)and PTC patients.Treg cells phenotypes(ICOS、PD-1、Lag3)and their IL-10 secretion ability were analayzed,along with functional molecules(TNF-α、IFN-γ、Granzyme B、Perforin)ex-pressed by NK cells.A cytometric bead array was used to measure serum cytokine IL-10 concentration.Changes in Treg and NK cells and their correlations were analyzed.Results Immune cell infiltration in PTC tissues is higher than in nodular goiter tissue.Compared with healthy controls,PTC patients exhibited a significant increase in the percentage[(6.86±3.10)％]and absolute count[(4.97±2.82 × 106 cells/mL)]of circulating Treg cells,with an enhanced IL-10 secretion capacity[(7.18±3.57)％],which is related to lymph node metastasis and vascular invasion.Con-versely,NK cell percentage[(16.56±8.44)％]and absolute count[(3.29±3.12 × 106 cells/mL)]were reduced,with impaired effector functions.The NK-to-Treg cell ratio(2.49±1.60)significantly declined,and a negative corre-lation was observed between the percentage of the two groups cell types(P=0.04,r=-0.625).Serum IL-10 levels in PTC patients were elevated[(1.30±1.09)pg/mL],correlating with tumor size and lymph node metastasis.After treatment with 1,25-(OH)2-D3,PTC patients showed a reduction in the percentage[(7.01±2.13)％]and absolute count(4.27±1.62 × 106 cells/mL)of circulating CD4+CD25+CD127low Treg cells,and a decrease in serum cytokine IL-10 levels[(1.27±0.09)pg/mL].Circulating NK cells percentages[(20.6±6.72)％]and absolute counts[(5.63±2.93)× 106 cells/mL]partially recovered.Conclusion PTC patients exhibit a pronounced immunosup-pressive state.Dysregulated numbers and functions of Treg and NK cells are closely associated with the occurrence,de-velopment,and prognosis of PTC,highlighting their potential importance in tumor immunotherapy.

Objective:To construct an evidence-based phased swallowing training program for patients after partial laryngectomy applying the Delphi method.Methods:Evidence was screened systematically applying evidence-basing principles to construct a first draft of a phased swallowing training program for patients after partial laryngectomy. After two rounds of Delphi expert consultation a final draft was formed.Results:The protocol was composed of 27 items covering 5 aspects of the gastrointestinal decompression period, the first- and second-stage continuous tube feeding periods, trial feeding of the intermittent tube feeding period and the oral feeding stage.Conclusion:The phased swallowing training program is scientifically sound and feasible in clinical practice. It can provide references for clinic staff to improve swallowing management.

Objective:To investigate the value of retrograde thyroidectomy from top to bottom in the operation of retrosternal thyroid surgery. Methods:Retrospective analysis was performed on the cases of retrosternal goiter excised by our surgeons from January 2017 to June 2022,the technical points, feasibility and advantages of the operation were summarized. Results:A total of 15 cases of retrosternal goiter treated by retrograde thyroidectomy were collected, including 5 cases of type Ⅰ retrosternal goiter and 10 cases of type Ⅱ retrosternal goiter.The postoperative pathology was benign. The surgical time is 40-60 minutes for unilateral retrosternal goiter and 70-90 minutes for bilateral goiter. All patients were discharged normally within 7 days after operation, and no operative complications were observed such as bleeding, hoarseness or hypoparathyroidism. Conclusion:This surgical excision method of thyroid is suitable for the type Ⅰ and type Ⅱ retrosternal goiter surgery, which can avoid the difficulties in exposing and separating the the inferior thyroid behind the sternum in conventional surgical method, speed up the operation and reduced the difficulty of operation, and has certain promotion value in clinic.
Humans ; Thyroidectomy/methods* ; Retrospective Studies ; Goiter, Substernal/pathology* ; Hypoparathyroidism/surgery*

Objective:To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer.Methods:A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Different treatments were carried out according to different complications. The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea. Patients with dyspnea immediately received ventilator-assisted ventilation. For those with massive hemorrhage on the wound, doctors should prevent bleeding and stop bleeding under general anesthesia. Patients with severely coughing should perform eating training to prevent food aspiration. The inner cannula was regularly replaced once a month for all of these patients.Results:Through targeted treatment, the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled. After dressing change, the neck wounds of 31 patients with neck infection were shrunk or healed. Finally, all of the patients were replaced with metal tracheal tubes. Eight cases with dyspnea were rescued with the symptomatic and related special treatment, and finally replace by metal tracheal tube. Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula. Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula.Conclusions:The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryngeal or hypopharyngeal cancer. It is strongly recommended that the operators should fully understand and use it reasonably after the operation of laryngeal or hypopharyngeal cancer.

Objective:To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer.Methods:A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Different treatments were carried out according to different complications. The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea. Patients with dyspnea immediately received ventilator-assisted ventilation. For those with massive hemorrhage on the wound, doctors should prevent bleeding and stop bleeding under general anesthesia. Patients with severely coughing should perform eating training to prevent food aspiration. The inner cannula was regularly replaced once a month for all of these patients.Results:Through targeted treatment, the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled. After dressing change, the neck wounds of 31 patients with neck infection were shrunk or healed. Finally, all of the patients were replaced with metal tracheal tubes. Eight cases with dyspnea were rescued with the symptomatic and related special treatment, and finally replace by metal tracheal tube. Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula. Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula.Conclusions:The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryngeal or hypopharyngeal cancer. It is strongly recommended that the operators should fully understand and use it reasonably after the operation of laryngeal or hypopharyngeal cancer.

Objective: To investigate the significance of lymphadenectomy using dissection and protection of carotid sheath and main nerves in treating complex benign disease of neck. Methods: A total of 54 cases with benign diseases in neck who received the protective surgical treatments were reviewed. There were 25 cases of recurrent branchial fistula, 15 cases of lymphoid tuberculosis, 5 cases of cystic hygroma, 5 cases of racemose angioma, and 4 cases of Madelung's disease. According to the location and extent of disease, all cases received operation with dissection and protection of carotid sheath and main nerves to removal lesions with lymphoid tissue and fat-connective tissue. Results: All cases recovered well, and no recurrence occurred with follow-up of 3 to 65 months. There was no other complication except for occurring of Horner syndrome in 1 patient. Conclusion The protective surgical method has certain application value in the treatment of benign neck diseases that have no indefinite boundary and widely distribute.