Objective To summarize the experience of intraoperative neuromonitoring (IONM) system for monitoring and protection of recurrent laryngeal nerve (RLN) during thyroid surgery.Methods A total of 220 cases were enrolled in this study (53 males and 167 females),with the median age of 38.2 years old.There were 85 cases of thyroid cancer,19 cases of thyroid benign tumor,90 cases of thyroid goiter,3 cases of Hashimoto's diseases,and 23 cases of hyperthyroidism.113 cases had tumors larger than 5 cm in diameter.During the procedure,2 recording needle electrodes were put in cricothyroid muscle and 1 stimulator electrode was explored in tracheoasophageal groove.If any RLN was fight there or nearby,doctors can see the electromyogram and hear the toothonk.With careful dissection,RLN can be found out till exploring into the larynx site.Results Electromyogram showed in 207 cases (278 nerves),and it didn't show in 13 cases,among whom 9 cases were false-negative because of system or annesthesia problems,4 cases didn't manage to have needle electrodes put in properly due to cricothyroid muscle being invaded.No permanent RLN paralysis occoured.Transient nerve paralysis occurred in 2 cases,who recovered in 1 month after operation.Conclusion IONM system is an effective way to avoid damage to RLN in thyroidectomy.

ObjectiveTo evaluate the safety and effectiveness of fast track surgery (FTS) in l aparoscopy-assisted radical distal gastrectomy (LADG) for gastric cancer.MethodsSixty-one patientswith distal gastric cancer were randomly divided into three groups:FTS + LADG group (n =19) undergoing LADG and FTS treatments,LADG group (n =22) undergoing LADG and traditional perioperative cares,and FTS + ODG ( open distal gastrectomy) group ( n =21 ) undergoing ODG and FTS treatments.FTS treatments included avoidance of mechanical bowel cleansing,restrictive perioperative intravenous infusion,early ambulation,early enteral nutrition.The age,sex,body weight,anastomotic mode,number of lymph node dissected,and tumor stage,serum albumin (ALB),blood urea nitrogen (BUN),C-reaction protein (CRP),flatus time,postoperative hospital stay,medical cost,and postoperative complications were compared between three groups. ResultsThe level of ALB in FTS + LADG group were higher than in LADG group at the 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.01 ).Compared to LADG group,the variation of ALB from preoperation to 4th day after surgery in FTS + LADG group and FTS + ODG group was significant( P ＜ 0.01,P ＜ 0.05 ).CRP level between FTS + LADG group and FTS + ODG group were different significantly at 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.05).FTS + LADG group has earlier recovery of gastrointestinal peristalsis than other two groups ( P ＜ 0.05,P ＜ 0.05 ).The medical cost in FTS + LADG group was less than in LADG group ( P =0.003 ),but higher than in FTS + ODG group (P ＜0.01 ).ConclusionsThe practice of FTS in LADG was safe,effective,improves nutritional status,eases stress reaction,accelerates gastrointestinal peristalsis and postoperative rehabilitation.

Objective To explore the efficiency of transcervical video-assisted mini-incision thyroidectomy for thyroid tumor. Methods 53 patients with thyroid tumors who underwent the video-assisted mini-incision thyroidectomy from Jan. 2006 to Dec. 2009 in the Department of Thyroid Surgery, Yantai Yuhuangding Hospital,were retrospectively studied. Results All of the patients, except 5 cases converting to open thyroidectomy, underwent the video-assisted mini-incision thyroidectomy successfully. The temporary recurrent laryngeal nerve injury occurred in 1 patients. The subcutaneous fluid accumulation occurred in 3 patients. The skin burns around the incisions occurred in 3 patients. There was no complication of hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period was from 3 months to 35 months. There was no evidence of recurrence and metastasis by postoperative ultrasonic and CT scan and radioiodine scintigraphy. Conclusions The video-assisted mini-incision thyroidectomy is feasible, safe, and with the advantage of cosmetic results. For thyroid tumor,especially thyroid cancer, longer follow-up is necessary to draw definitive conclusion on recurrence and survival rate.

Objective To explore the clinical manifestations, diagnosis, treatment and prognosis of secondary thyroid neoplasms. Methods To retrospectively analyse clinical manifestations,examinations and treatment of 83 cases of secondary thyroid cancer, which were retrieved from CNKI (1994-2008). Results In all cases, 39 were male, 39 were female and 5 were unknow, aged from 16 to 78 years old, median age was 52. The primary cancers included 31 esophageal carcinomas, 12 lung cancers, 8 laryngopharynx cancers, 7 clear cell renal carcinomas, 6 rectal carcinomas, 6 melanomas, 3 breast cancers, 3 rhabdomyosarcoma, 2 gatric cancers, 1 liver cancer, 1 cervical cancer, 1 nonchromaffin paraganglioma,1 ovary cancer, 1 lip squamous cell carcinomac. 64 patients had undergone chemotherapy or surgery or radiotherapy. The intervals between finding of primary carcinoma and secondary thyroid carcinoma ranged from 1 month to 26 years with a median time of 2.5 years. Patients died of widespread metastases from 1 month to 12 years following the diagnosis of secondary carcinoma in thyroid, with a median time of 32 months. Conclusions Metastasis in the thyroid gland is uncommon and may cause a diagnostic problem. Metastatic cancer to the thyroid should be considered when a patient with histoy of malignant tumor has a recent found thyroid lesions. With the combination of Surgery, chemotherapy and radiotherapy, the survival of patients can be significantly prolonged.

Objective To explore the feasibility and efficiency of minimally invasive video-assisted thy-roidectomy on thyroid microcarcinoma, and sum up the experiences. Methods 9 patients with thyroid microcarci-noma who underwent the minimally invasive video-assisted thyroidectomy from Jan 2006 to Feb 2009, were retro-spectively studied. Results All of the patients, except 1 case converting to open thyroidectomy, underwent the minimally invasive video-assisted thyroidectomy successfully. The subcutaneous hydrops occurred in 1 patient. The skin burns around the incisions occurred in 1 patient. There were no complications of recurrent laryngeal nerve injuries, neck hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period of 15 cases were from 3 months to 37 months. There were no evidences of recurrence and metastasis by both postopera-five ultrasonic/CT examination and radioiodine scintigraphy. Conclusions The minimally invasive video-assisted thyroidectomy is safe and feasible (similar to the traditional thyroidectomy), of gratifying cosmetic results, for low-risk differentiated thyroid microcarcinoma without lymph node metastasis. For the median-risk or high-risk, more patients, comparative studies and long follow-ups are necessary to draw definitive conclusions in terms of its recurrence and survival rate.

Objective To study a rational method of pancreaticojejunostomy after pancreatoduodenectomy.Methods Retrospective analysis was made on the clinical material of 108 cases of bundle-invagination(pancreaticojejunostomy) after pancreatoduodenectomy performed from Jan 1996 to Dec 2003 in our department.Results The operative time was 3.5~4.5 hours.No perioperative death nor pancreatic fistula occurred.One diabetic patient developed biliary fistula on the 8~(th) post-operative day and it healed spontaneously after drainage.Two cases had wound dehiscence that healed after tension relaxation suture.Two cases of(postoperative) gastroparesis recovered after conservative treatment.Conclusions The bundle-invagination(pancreaticojejunostomy) can more effectively prevent pancreatic fistula and have less operation time.