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asbryobvrz · Wysłany: Pią 19:09, 25 Mar 2011

Diagnosis and Treatment of thyroid cancer

Functions. 1.4 surgical anesthesia or cervical plexus anesthesia, low collar incision are used for small carcinoma of the primary tumor side of the isthmus of thyroid lobectomy + resection. The remaining functional thyroid cancer neck dissection done,[link widoczny dla zalogowanych], place the skin graft after conventional or negative pressure drainage. 2 Results Results 1 case of recurrent laryngeal nerve injury. Patients with hoarseness. Parathyroid crisis and no complications such as hypothyroidism. All patients were given a music excellent oral and adjusted according to the level of thyroid function. 5-year follow-up, showed no recurrence. 1 case proved to be cancer, the hospital 2 times higher after the transfer operation. 3 Discussion (1) improve the preoperative diagnosis of thyroid cancer rate is very necessary, and to overcome were misdiagnosed,[link widoczny dla zalogowanych], mainly to raise awareness and make the following aspects: ① emphasis on history and physical examination. Timely detection of thyroid nodules and enlarged lymph nodes; without hoarseness and so on. Also note that identification with other thyroid diseases. ② Select the necessary examinations. B-is the preferred method of examination of thyroid nodules, can be found l ~ 3ram small nodules. Hypoechoic irregular or if, the edge is not sharp, no capsule, and cervical lymph nodes calcification within nodules, thyroid cancer should be highly suspected. The 24 cases of preoperative B-consider thyroid cancer, including 3 cases of small cancer. Can afford to choose some new methods: such as spiral CT, 99mTc-mLBI imaging method, pet ~ CT, epithelial membrane antigen, monoclonal antibody immunohistochemical examination to do so, can differentiate benign and malignant thyroid nodules disease . Detailed analysis of test results should be made, not misleading. (2) the recurrent laryngeal nerve injury and hypoparathyroidism is thyroid surgery one of the most serious complications. Thyroid surgery recurrent laryngeal nerve injury caused by medical malpractice has been set, how to avoid common complications of recurrent laryngeal nerve injury that is very important. The group found that 3 cases of thyroid cancer tumor and the recurrent laryngeal nerve adhesion, postoperative patients with hoarseness in 1 case. Reported in the literature in thyroid surgery recurrent laryngeal nerve injury rate of 1.9% ~ 17.0% .... Here to discuss our surgical experience: ① addition to the familiar outside the recurrent laryngeal nerve and parathyroid anatomy. Should not be too small incision surgery. Exposure must be good. Operative field clear. Complete hemostasis, gentle operation. ⑦ free gland after the first break of the isthmus, the isthmus ends from the beginning to the affected side, in the thyroid really is outside of the membrane after removal of the thyroid to retain part of the thyroid after the capsule to avoid the recurrent laryngeal nerve anatomy. But also to avoid the recurrent laryngeal nerve damage. ③ When the lower pole of the thyroid treatment. Do not mention the lower pole of the thyroid following the post clamp. To avoid the recurrent laryngeal nerve was filed after the fire. Can be close to the thyroid capsule treatment of vascular branches,[link widoczny dla zalogowanych], rather than deal with the inferior thyroid artery, after the thyroid capsule to preserve, so you can try to avoid the recurrent laryngeal nerve and parathyroid gland. ④ gland resection. In case of tracheoesophageal groove and the cricothyroid membrane at the bleeding line of suture needle should be. Ligation to avoid the large organizations,[link widoczny dla zalogowanych], but should avoid electric knife electrocautery to stop bleeding, accidental injury of recurrent laryngeal nerve. ⑤ Non anesthesia who called the surgery the patient to speak. Found hoarseness, recurrent laryngeal nerve injury at once to find,[link widoczny dla zalogowanych], such as by ligation, immediately loose knot. If they are cut off. Immediately with no damage suture, end to end to the joint, only the joint capsule can be nervous, to avoid excessive influence of free nerve and blood supply. (3) In particular, papillary thyroid cancer with lymph node metastases reported 1173 cases and other claims Lun papillary thyroid cancer lymph nodes before surgery does not touch. The pathological examination after neck dissection, the metastasis rate was 65.8%. The group found that B-15 cases cervical lymph nodes. Under the jugular vein in the lymph nodes, where nodes when to send quick pathological examination confirmed the transfer, that is, cervical lymph node dissection; If the lymph nodes and internal jugular vein and nerve adhesion serious. The line of traditional neck dissection. (4) Quick intraoperative frozen section examination. Line should be routine thyroid nodule surgery carried out intraoperative frozen section examination. For the diagnosis of thyroid nodules is not particularly important, so surgery is not complete, general surgery in the diagnosis rate of quick frozen in 85% to 95%; less than 1% false positive and false negative rate (10%). Therefore, as the indication for thyroid cancer diagnosis. But also the initial classification, so that patients receive timely diagnosis and appropriate treatment. 31 cases of thyroid cancer in this group, intraoperative frozen section diagnosis in 29 cases.