Effect of local spraying of <i>Pseudomonas aeruginosa</i> injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Yu , ZENG Cuifang , ZOU Xiuhe , LEI Jianyong , ZHENG Xun , LI Zhihui , GONG Rixiang , ZHU Jingqiang ,  WEI Tao

Department of Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WEI Tao, Email: weitaohxsurgeon@163.com

Keywords：

papillary thyroid cancer; center neck dissection; recurrent laryngeal nerve; Pseudomonas aeruginosa injection; local spraying

DOI：

10.7507/1007-9424.202004004

Video：

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Objective To evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).Methods From Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.Results The two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.Conclusion After total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.

Citation： MA Yu, ZENG Cuifang, ZOU Xiuhe, LEI Jianyong, ZHENG Xun, LI Zhihui, GONG Rixiang, ZHU Jingqiang, WEI Tao. Effect of local spraying of Pseudomonas aeruginosa injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1496-1500. doi: 10.7507/1007-9424.202004004 Copy

1.	朱精強, 蘇安平. 甲狀腺結節手術治療的合理選擇. 中國實用外科雜志, 2015, 35(6): 635-639.
2.	魏濤, 朱信心, 陳銳, 等. 銅綠假單胞菌注射液治療甲狀腺癌頸部淋巴結清掃術后淋巴漏的臨床分析. 中國普外與基礎雜志, 2013, 20(3): 325-327.
3.	Zhang M, Luo F, Zhang Y, et al. Pseudomonas aeruginosa mannose-sensitive hemagglutinin promotes T-cell response via toll-like receptor 4-mediated dendritic cells to slow tumor progression in mice. J Pharmacol Exp Ther, 2014, 349(2): 279-287.
4.	Zhang C, Zhang Z, Wang L, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection treated cytokine-induced killer cells combined with chemotherapy in the treatment of malignancies. Int Immunopharmacol, 2017, 51: 57-65.
5.	牟希亞. 綠膿桿菌甘露糖敏感血凝菌毛株的首次選育建株. 大連醫學院學報, 1985, 1: 1-3.
6.	Fass R, van de Walle M, Shiloach A, et al. Use of high density cultures of Escherichia coli for high level production of recombinant Pseudomonas aeruginosa exotoxin A. Appl Microbiol Biotechnol, 1991, 36(1): 65-69.
7.	洪義東, 胡楠, 卞寶祥, 等. 銅綠假單胞菌注射液抗腫瘤作用及其相關機制的研究進展. 中國現代應用藥學, 2019, 36(2): 256-259.
8.	Agrawal N, Evasovich MR, Kandil E, et al. Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement. Head Neck, 2017, 39(7): 1269-1279.
9.	張鳳華, 賈玉杰. 銅綠假單胞菌注射液輔助治療惡性腫瘤的應用進展. 大連醫科大學學報, 2010, 32(4): 479-482.
10.	Liu XF, Wang L, Qu Y, et al. Effect of the PA-MSHA vaccine on septic serum-induced inflammatory response. Mol Med Rep, 2013, 7(4): 1350-1354.
11.	Hou J, Liu Y, Liu Y, et al. The MSHA strain of Pseudomonas aeruginosa activated TLR pathway and enhanced HIV-1 DNA vaccine immunoreactivity. PLoS One, 2012, 7(10): e47724.
12.	董若凡. 銅綠假單胞菌注射液對宮頸癌術后淋巴液引流的影響. 實用臨床醫學, 2018, 19(12): 38-39.
13.	Wei T, Liu F, Li ZH, et al. Novel management of intractable cervical chylous fistula with local application of Pseudomonas aeruginosa injection. Otolaryngol Head Neck Surg, 2015, 153(4): 561-565.
14.	Chen Q, Chen Y, Su A, et al. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: two case reports. Medicine (Baltimore), 2020, 99(5): e18816.
15.	Chen Q, Zou X, Ma Y, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection therapy for the treatment of chyle fistula following neck dissection. Head & Neck, 2020, 42(4): 725-731.
16.	訾聃, 何麗萍, 楊英捷, 等. 銅綠假單胞菌注射液局部噴灑及皮下注射對宮頸癌患者術后淋巴液引流量的影響. 山東醫藥, 2011, 51(34): 80-81.
17.	馬富懿, 王禮泉, 王昌亮, 等. 銅綠假單胞菌注射液在乳腺癌切除術后皮下積液中的臨床應用. 中華腫瘤防治雜志, 2009, 16(14): 1111-1112, 1119.
18.	謝凡, 張家洪. 銅綠假單胞菌注射液胸腔灌注治療惡性胸腔積液的臨床分析. 臨床肺科雜志, 2016, 21(3): 528-530.
19.	朱亞芳, 魏金芝, 顧洪兵. 銅綠假單胞菌注射液腔內注入治療 23 例惡性心包積液的臨床觀察. 現代腫瘤醫學, 2011, 19(12): 2458-2459.
20.	王北, 吳應盛, 張珉. 銅綠假單胞菌注射液治療 Whipple 術后淋巴漏的臨床分析. 中國現代藥物應用, 2015, 9(19): 150-151.
21.	Genpeng L, Jinen S, Tao W, et al. Intraoperative application of inactivated Pseudomonas aeruginosa in patients undergoing lateral neck dissection for metastatic thyroid cancer: A randomized, parallel group, placebo-controlled trial. Surgery, 2020, 168(2): 340-346.
22.	Roh JL, Yoon YH, Park CI. Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma. Ann Surg Oncol, 2008, 15(9): 2576-2580.
23.	Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck, 2018, 40(1): 7-15.
24.	Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.

1. 朱精強, 蘇安平. 甲狀腺結節手術治療的合理選擇. 中國實用外科雜志, 2015, 35(6): 635-639.
2. 魏濤, 朱信心, 陳銳, 等. 銅綠假單胞菌注射液治療甲狀腺癌頸部淋巴結清掃術后淋巴漏的臨床分析. 中國普外與基礎雜志, 2013, 20(3): 325-327.
3. Zhang M, Luo F, Zhang Y, et al. Pseudomonas aeruginosa mannose-sensitive hemagglutinin promotes T-cell response via toll-like receptor 4-mediated dendritic cells to slow tumor progression in mice. J Pharmacol Exp Ther, 2014, 349(2): 279-287.
4. Zhang C, Zhang Z, Wang L, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection treated cytokine-induced killer cells combined with chemotherapy in the treatment of malignancies. Int Immunopharmacol, 2017, 51: 57-65.
5. 牟希亞. 綠膿桿菌甘露糖敏感血凝菌毛株的首次選育建株. 大連醫學院學報, 1985, 1: 1-3.
6. Fass R, van de Walle M, Shiloach A, et al. Use of high density cultures of Escherichia coli for high level production of recombinant Pseudomonas aeruginosa exotoxin A. Appl Microbiol Biotechnol, 1991, 36(1): 65-69.
7. 洪義東, 胡楠, 卞寶祥, 等. 銅綠假單胞菌注射液抗腫瘤作用及其相關機制的研究進展. 中國現代應用藥學, 2019, 36(2): 256-259.
8. Agrawal N, Evasovich MR, Kandil E, et al. Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement. Head Neck, 2017, 39(7): 1269-1279.
9. 張鳳華, 賈玉杰. 銅綠假單胞菌注射液輔助治療惡性腫瘤的應用進展. 大連醫科大學學報, 2010, 32(4): 479-482.
10. Liu XF, Wang L, Qu Y, et al. Effect of the PA-MSHA vaccine on septic serum-induced inflammatory response. Mol Med Rep, 2013, 7(4): 1350-1354.
11. Hou J, Liu Y, Liu Y, et al. The MSHA strain of Pseudomonas aeruginosa activated TLR pathway and enhanced HIV-1 DNA vaccine immunoreactivity. PLoS One, 2012, 7(10): e47724.
12. 董若凡. 銅綠假單胞菌注射液對宮頸癌術后淋巴液引流的影響. 實用臨床醫學, 2018, 19(12): 38-39.
13. Wei T, Liu F, Li ZH, et al. Novel management of intractable cervical chylous fistula with local application of Pseudomonas aeruginosa injection. Otolaryngol Head Neck Surg, 2015, 153(4): 561-565.
14. Chen Q, Chen Y, Su A, et al. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: two case reports. Medicine (Baltimore), 2020, 99(5): e18816.
15. Chen Q, Zou X, Ma Y, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection therapy for the treatment of chyle fistula following neck dissection. Head & Neck, 2020, 42(4): 725-731.
16. 訾聃, 何麗萍, 楊英捷, 等. 銅綠假單胞菌注射液局部噴灑及皮下注射對宮頸癌患者術后淋巴液引流量的影響. 山東醫藥, 2011, 51(34): 80-81.
17. 馬富懿, 王禮泉, 王昌亮, 等. 銅綠假單胞菌注射液在乳腺癌切除術后皮下積液中的臨床應用. 中華腫瘤防治雜志, 2009, 16(14): 1111-1112, 1119.
18. 謝凡, 張家洪. 銅綠假單胞菌注射液胸腔灌注治療惡性胸腔積液的臨床分析. 臨床肺科雜志, 2016, 21(3): 528-530.
19. 朱亞芳, 魏金芝, 顧洪兵. 銅綠假單胞菌注射液腔內注入治療 23 例惡性心包積液的臨床觀察. 現代腫瘤醫學, 2011, 19(12): 2458-2459.
20. 王北, 吳應盛, 張珉. 銅綠假單胞菌注射液治療 Whipple 術后淋巴漏的臨床分析. 中國現代藥物應用, 2015, 9(19): 150-151.
21. Genpeng L, Jinen S, Tao W, et al. Intraoperative application of inactivated Pseudomonas aeruginosa in patients undergoing lateral neck dissection for metastatic thyroid cancer: A randomized, parallel group, placebo-controlled trial. Surgery, 2020, 168(2): 340-346.
22. Roh JL, Yoon YH, Park CI. Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma. Ann Surg Oncol, 2008, 15(9): 2576-2580.
23. Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck, 2018, 40(1): 7-15.
24. Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.

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Effect of local spraying of Pseudomonas aeruginosa injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection

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