目的 探讨利用特殊手术器械和相应的手术操作技巧对提高甲状腺外科手术的安全性及质量的作用。方法 借助MPBS系列器械和超声刀的推剥、分离、切割、止血等技术完成甲状腺手术。结果 完成甲状腺部分切除、次全切除或侧叶切除术共468例，手术时间（40±20）min，术中出血量（30±25）ml，住院时间（4±1）d；切口细小，瘢痕平整；术后出现短暂声嘶3例，饮水呛咳2例，局部皮下积液2例。随诊1～3年，平均1.8年，3例复发，1例甲状腺功能低下。无甲状旁腺功能低下和永久性神经损伤病例。结论 利用MPBS器材和超声刀技术在甲状腺疾病外科治疗中的应用安全可靠，具有手术安全、简捷、出血少、时间短、切口小、副损伤少、恢复快的临床效果，值得进一步推广和探讨。
ObjectiveTo investigate the diagnosis, treatment, classification, and epidemiology of thyroid tuberculosis. MethodsA retrospective study of 5 cases of thyroid tuberculosis and a review of the literatures were analyzed, which related to the clinical characteristics, the gist of the diagnosis and treatment, the causes of misdiagnosis and the methods of operation. ResultsAll of the cases were misdiagnosed before operation. Two cases were diagnosed by the frozen sections during the operations and three cases were diagnosed by postoperative pathology. Subtotal resection or lobectomy and local excision (3 cases) were performed respectively. Debidement and anti-tuberculosis medicine were given locally in 2 unresectable cases. All patients underwent standard chemotherapy for 6－8 months after operations and recovered finally. Four cases were caseous necrosis, 1 case was hyperplasia, all of which were chronic infections thyroid tuberculosis, and no acute thyroid tuberculosis be found. No recurrence was found in the 2－15 years of follow-up. ConclusionsUsually, it is difficult to establish a definite preoperative diagnosis for thyroid tuberculosis. Treatment, such as resection, debridement with local medication or systemic chemotherapy, shall be taken individually according to pathology types, focal features, and comorbidities. For hyperplasia cases, surgical resection shall be the best choice, while, for caseous necrosis cases, sometime difficult to remove, debridement with local medication may be suitable.
Objective To summarize the advanced researchs of autoimmune thyroid disease(ATD) complicated with differentiated thyroid cancer (DTC). Methods The related literatures about concurrent ATD and DTC were consulted and reviewed. Results Hashimoto diseas (HD) complicated with DTC at home and abroad were reported more and more, whether merging with HD or other ATD disease could affect the prognosis of papillary thyroid cancer (PTC) was a controversial topic. HD and DTC (mainly PTC) had some same epidemiological and molecular features. Conclusion Better understanding of clinical pathology and characteristic of DTC concurrent with ATD can provide some new insights to immunotherapy for DTC.
ObjectiveTo summarize and analyze the possible association between thyroid diseases and alopecia areata. MethodThe literatures on the relationship between thyroid disease and alopecia areata in recent years were searched and reviewed. ResultsAmong individuals with alopecia areata, the risk of thyroid disease was heightened. They were more susceptible to autoimmune thyroid conditions, often accompanied by thyroid function abnormalities. Moreover, alopecia areata patients face an increased risk of thyroid cancer. However, in patients with thyroid disease, the change of the incidence of alopecia areata was not completely clear. The risk of alopecia areata was increased in patients with autoimmune thyroid disease, and abnormal thyroid function may be one of the potential reasons for the persistence of alopecia areata. ConclusionsAutoimmune thyroid disease and alopecia areata may have a common disease basis. Patients with alopecia areata are at greater risk of autoimmune thyroid disease and thyroid dysfunction. The increased risk of alopecia areata in patients with autoimmune thyroid disease may be related to abnormal thyroid function.
Objective To investigate the clinical significance of the three iodide transporters in thyroid diseases. Methods Literatures about the Na+/I- symporter (NIS), pendrin and human apical iodide transporter (hAIT) in recent years were reviewed and their expressions in different thyroid diseases were also analyzed. Results NIS proteins express at the basolateral membrane of thyrocytes in normal thyroid tissue, while pendrin and hAIT proteins are limited to the apical membrane of thyrocytes lining in the follicular lumen. In the tissues of thyroid carcinomas, it was found that the NIS proteins expressed in the cytoplasm and their expressions decreased; The mutation of NIS gene may be one of the main causes of congenital hypothyroidism. The expression of prendrin protein may be related to the function of follicles: its expression level increased significantly both in Graves diseases and toxic adenomas, but significantly decreased in differentiated thyroid carcinoma. However, the correlation between the decrease and the degrees of differentiation of carcinoma cell line are still disputable. The expression of hAIT protein does not significantly altered in hyperfunctioning tissues. It only slightly decreased occasionally in hypofunctioning adenomas, but it decreased significantly in thyroid carcinomas. Conclusion The abnormal expressions of the three iodide transporters may be related closely with the type of thyroid diseases. However, their pathogenic mechanisms and the causes of their abnormal expression are still unknown, which need to be studied further.
Objective To reveal the relationship between the iodine nutrition and the change of spectrum of thyroiddiseases by analyzing the change of spectrum of thyroid diseases in different iodine environments before and after the implementation of universal salt iodization （USI）. Methods To compare the urinary iodine concentration between the normal people （1 000 cases） and the patients with thyroid diseases （5 998 cases） by surgical operations who were from 4 cities of Guangxi Zhuang Autonomous Region， covering the iodine deficient areas and the iodine rich areas. Results After the USI was put into practice， the proportions of nodular goiter decreased， but the proportions of toxic nodular goiter， thyroid papillary carcinoma， and Hashimoto thyroiditis were higher than those before USI （P＜0.05）. The urinaryiodine concentrations of nodular goiter， Graves disease， toxic nodular goiter， thyroid papillary carcinoma， and Hashimotothyroiditis were higher than those before the measure was taken （P＜0.05）. The urinary iodine concentration of patients with thyroid was higher than that of normal people （P＜0.05）， and the urinary iodine concentration of patients with thyroidand normal people was higher than those before the USI （P＜0.05）. Conclusions The change of spectrum of thyroid diseases in Guangxi Zhuang Autonomous Region is obvious within 10 years after USI had been taken. The excessive intake of iodine may be one of the dangerous factors leading to toxic nodular goiter， thyroid papillary carcinoma， and Hashimoto thyroiditis.
ObjectiveTo summarize the advancement of transoral endoscopic thyroidectomy vestibular approach (TOETVA).MethodThe relevant literatures about comparative study btween TEOTVA and other thyroidectomy were retrospectively analyzed and summarized.ResultsCompared with the conventional open thyroidectomy or other endoscopic thyroidectomy, even though TOETVA requires a longer operative time, it provides similar surgical outcomes and no scar on the body.ConclusionTOETVA is a safe and effective procedure with excellent cosmetic results for patients with thyroid disease.
【摘要】目的探讨经乳房途径行腔镜甲状腺切除术的可行性。方法2003年12月至2004年6月期间我科行腔镜甲状腺切除术27例。于两侧乳晕及乳头间切口放置3个trocar，分离胸前皮下和颈阔肌深面，注入CO2建立手术操作空间，CO2压力为5~6 mm Hg，超声刀切割、分离甲状腺组织和甲状腺血管。结果13例行甲状腺肿块切除术，11例行一侧腺叶次全切除术，3例行双侧甲状腺次全切除术。手术时间70~140 min，平均（97±34.2） min； 术中出血20~40 ml，平均（34±9.7） ml； 术后住院时间3~5 d，平均（3.6±0.8） d。27例手术均获成功，无一例中转手术及并发症发生。结论经乳房途径的腔镜甲状腺切除术安全、可靠，颈部无疤痕，美容效果好。