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Prevention of Recurrent Laryngeal Nerve Injury During The Reoperation for Recurrent Thyroid Carcinoma

Rational Management of Thyroid Cancer Incidentally Found During and after Thyroid Nodule Surgery

甲状腺微小乳头状癌的细针穿刺及手术时机的把握

浅谈细针穿刺活检诊断甲状腺微小癌的技巧

乳头溢液的个体化诊断流程

甲状腺术后切口感染抗坏血酸克吕沃尔菌伴窦道经久不愈1例报道

目的探讨甲状腺术后切口感染及颈部窦道形成原因及临床诊治经验。 方法回顾性分析笔者所在医院收治的1例甲状腺术后切口感染抗坏血酸克吕沃尔菌伴颈部窦道形成的临床病例资料，并检索国内外文献以分析切口感染原因，总结临床诊治要点。 结果本例患者因结节性甲状腺肿伴甲状腺腺瘤在外院行甲状腺双叶次全切除术，术后发生切口感染及颈部窦道形成且经久不愈（4年），切口分泌物细菌培养为抗坏血酸克吕沃尔菌，遂收治于笔者所在医院，在加强抗感染基础上应用术中神经监测和精细化被膜外操作技术行窦道脓腔及基底部腺体组织一并切除术，术后11 d治愈出院，无并发症发生，随访半年无复发。抗坏血酸克吕沃尔菌是一种不常见的条件致病菌，本例患者的感染可能系因异物置入所致。 结论甲状腺手术应谨慎应用止血填充物；对于颈部窦道，手术彻底切除是唯一的治疗手段；在高风险、复杂甲状腺手术中应用神经监测技术、进行精细化被膜外操作，有助于保护喉返神经和甲状旁腺，提高手术安全性。

The Hot Point and Difficult Key Point in Surgical Treatment of Thyroid Disease

甲状腺外科疾病常见，有许多进展和进步，这是热点； 但许多治疗意见不一，分歧极大，长久难以统一，故又有许多难点

Investigation of Succession Model for Goiter in Iodine Deficiency Area

ObjectiveTo investigate the succession model for hyperthyroidism and thyroid carcinoma secondary to nodular goiter in iodine deficiency area. MethodsA total of 216 specimens of goiter patients from iodine deficiency area were collected in the former 3rd hospital of Norman Bethune Medical College from January 1980 to December 1994. Twentyfour heteroploid samples were selected by the method of Hedley with Flow cytometry (FCM) analysis. Paraffin-embedded tissues from the same position were used to perform immunohistochemical staining for proliferating cell nuclear antigen (PCNA), laminin (LN), factor Ⅷ related antigen (FⅧ-RAg), and p53. The proliferative activity, stroma change, and angiogenesis were observed. ResultsPCNA label index (PCNA-LI) and proliferation index (PI) consistent in 24 heteroploid samples with PCNA staining were significantly higher value. PCNA positive cells were mainly distributed over nonfollicular parenchymatous structures, small follicles, and multilayered structures with large bubbly follicles. Destroyed basement membrane and necrosis were found by LN staining in PCNA positive position with vigorous reproductive capacity. Combining FⅧ-RAg staining with LN staining, interstitial proliferation and angiogenesis were obvious in follicular epithelial cells with vigorous reproductive capacity, providing nutrition and superior environment for them. ConclusionsThe reproduction of thyroid follicular epithelial cells, interstitial proliferation, and angiogenesis are all involved in tuberosis and hyperthyroidism, forming precancerous lesion, which suggest the succession model of goiter in iodine deficiency area.

Study on Extent of Operation for Differentiated Thyroid Carcinoma

1 例具特殊影像特征甲状腺髓样癌的诊治体会并文献复习

目的 探讨具特殊影像特征的甲状腺髓样癌（MTC）的临床诊治策略。 方法 回顾性分析笔者所在医院于 2016 年 11 月收治的 1 例 MTC 病例的临床资料和诊治经过，并进行文献复习。 结果 该例患者的颈部超声检查表现为甲状腺腺瘤征象，术前血清降钙素（Ctn）检查结果异常升高，复查 Ctn的同时行血清癌胚抗原（CEA）、细针穿刺细胞学检查（FNA）及洗脱液 Ctn 检查，结果均提示 MTC 可能。根据术前影像学检查和术中病理检查结果行甲状腺癌根治术，术后病理确诊为 MTC。 结论 超声检查下不典型征象结节往往是 MTC 误诊的主要原因，故对于尚不能排除 MTC 可能者应该考虑进一步行血清 Ctn、血清 CEA、FNA、洗脱液 Ctn 等检查以明确诊断，避免延误治疗。