Objective To explore the feasibility and safety of removal of benign substernal goiter through cervical approach and summarize the operation skill. Methods The clinical data of 85 cases diagnosed as benign substernal goiter from August 2002 to October 2011 in this hospital were analyzed retrospectively. Results The removal of benign substernal goiters in all 85 cases were performed through cervical approach without perioperative death，respiratory tract obstruction，massive haemorrhage，pneumothorax，hemothorax，chylus leakage，permanent impairment of recurrent laryngeal nerve，and permanent hypoparathyroidism. Three cases of hoarseness were found on 1-3d after operation，which returned to normal after symptomatic treatment. Four cases of numbness in the extremities and one case of mild convulsion happened，the symptoms were relieved through intravenous and oral administration of calcium treatment in 3-7d. The drainage volume was 35-220ml with （68±4.9） ml. The drainage tube was removed on postoperative 2-6d with an average 4.2d. Eighty-two patients were followed-up in 2 years after operation，no low calcium，low parathyroid hormone，hoarseness，and local goiter recurrence occurred. Two cases of hypothyroidism returned to normal after oral thyroxine dose adjustment. Conclusions Removal of the downward benign substernal goiter through cervical approach is safe and feasible. Sufficient exposure，stepwise procedure，blunt dissection in the precise gap，and combination of lifting with upbearing are the surgical skills for success.
Objective To explore the feasibility and safety of endoscopic thyroidectomy via chest-breast approachand summarize the operation skill. Method The clinical data of 40 cases performed endoscopic thyroidectomy via chest-breast approach from August 2010 to August 2012 in this hospital were analyzed retrospectively. Results The endoscopic thyroidectomies via chest-breast approach were successfully performed in all 40 patients without conversion to open surgery， massive haemorrhage， hypercapnia， severe subcutaneous emphysema， cutaneous necrosis on chest，permanent impairment of recurrent laryngeal nerve， and permanent hypoparathyroidism. One case of hoarseness was found on 2d after operation， who returned to normal after symptomatic treatment. One case of numbness in the extremitieshappened on day 2 after operation and the symptom was relieved through intravenous and oral administration of calcium treatment in 3d. One case of cutaneous tightness on chest happened， and it was spontaneous remission in a month. The operation time was （102±28.4） min （55-182 min）， intraoperative bleeding was （46±16.6） mL （30-106 mL）， and the drainage tube was removed postoperative 2-7d with an average （4±2.2） d， the postoperative hospitalization was 3-8 d with an average （4±1.1） d. All of the cases were followed-up after operation without low calcium， low parathyroid hormone， hoarseness， and local goiter recurrence. Two cases of hypoparathyroidism returned to normal after oral thyroxine dose adjustment. All the patients were satisfied with the cosmetic results. Conclusions The endoscopic thyroidectomy via chest-breast approach is safe and feasible with good cosmetic results. The subcutaneous Y tunnel， the “upper yellow middle white lower red” appearance on the chest， and the landmark of inverse trapezium on the neck are the key points for creation of operation compartment. Sufficient exposure， stepwise procedure， blunt dissection combined with sharp dissection in the precise gap are the surgical skills for endoscopic thyroidectomy.
Objective To investigate the clinical diagnosis and treatment for primary hyperparathyroidism with concomitant thyroid diseases. Methods The clinical data of 40 cases diagnosed as primary hyperparathyroidism with concomitant thyroid diseases including manifestation, preoperative qualitation and localization, and surgical treatment and results were retrospectively analyzed. Results The 40 cases were composed of 4 parathyroid adenomas with thyroid papillary carcinomas, 28 parathyroid adenomas with nodular goiters, 6 parathyroid adenomas with thyroid adenomas, 1 parathyroid hyperplasia with nodular goiter, and 1 parathyroid carcinoma with thyroid adenoma. The diagnostic sensitivities of localization for primary hyperparathyroidism with concomitant thyroid diseases by ultrasound, by computerized tomography (CT), and by radioisotope (99Tcm) scanning were 82.5% (33/40), 80.0% (32/40) and 90.0% (36/40), respectively, and the combined sensitivity was 97.5% (39/40). The surgical treatments included resection of parathyroid adenoma with subtotal thyroidectomy in 34 cases, resection of parathyroid adenoma with total thyroidectomy in 3 cases, bilateral exploration of parathyroid with subtotal thyroidectomy in 1 case, and unilateral parathyroidectomy with thyroidectomy and neck lymphonodes clearance in 2 cases. ConclusionFor primary hyperparathyroidism with concomitant thyroid diseases, the sensitivity of preoperative localization could be raised by combining ultrasound, CT with radioisotope scanning, and surgical resection is the main treatment, which includes the main operation of resection of parathyroid adenoma with subtotal or total thyroidectomy.
Objective To develop an in vitro three-dimensional angiogenesis system and analyze the expression and function of CD105 in angiogenesis. Methods After primary human umbilical vein endothelial cells (HUVEC) were purified and cultured, the microcarriers were coated with HUVEC and then embedded and cultured into fibrin gel. The angiogenesis process of HUVEC on the microcarriers was formed. The expression of CD105 during this process was detected by reverse transcription polymerase chain reaction (RT-PCR). Antisense oligodeoxynucleotide (ASODN) was used to inhibit the expression of CD105 and the changes of the angiogenesis process were analyzed quantitatively. Results HUVEC on the microcarriers which were embedded into the fibrin gel, occurred the angiogenesis process of sprouts, branches and capillary networks with lumina. During this process, CD105 was over expressed in the periods of forming sprouts and branches, and depressed in the relatively steady periods including the periods before forming sprouts and after forming capillary networks. While the expression of CD105 was inhibited by ASODN, the angiogenesis process was significantly inhibited. Conclusions The expression of CD105 is varied within the angiogenesis process, over expressing during the sprouts and branches forming periods. Inhibiting the expression of CD105 could efficiently inhibit angiogenesis.
目的 建立基于反傳（BP）神經網絡技術的甲狀腺癌診斷模型，并評估該模型的臨床應用價值。方法 回顧性分析2010年1月至2011年8月期間南京市鼓樓醫院收治的甲狀腺癌患者103例及甲狀腺良性病變患者51例，提取其超聲圖像的9個特征，循建模規則，建立基于BP神經網絡技術的甲狀腺癌診斷模型，依此模型對2011年9月至2011年12月期間收治的根據超聲圖像特征疑為甲狀腺癌的42例患者進行術前診斷，其結果與術后病理診斷結果（術后病理診斷為甲狀腺癌32例，甲狀腺良性病變10例）進行對比研究。結果 甲狀腺癌診斷模型對建模樣本的診斷準確率為95.45%（147/154）；術前樣本的診斷準確率為90.48%（38/42）；所有樣本的診斷準確率為94.39% （185/196）。結論 從本組有限的病例結果初步得出，基于BP神經網絡技術的甲狀腺癌診斷模型具有較高的可行性及可靠性，可望成為一種全新的甲狀腺癌輔助診斷方法。