Abstract:Abstract:Objective:To investigate the therapeutic effect of operation for the recurrent larygeal nerve (RLN) injury caused by thyroid operation.
Methods :Fiftyseven cases of RLN injury caused by thyroid operation during past 38 years and its causes, location, types and curative effect were retrospectively analyzed.
Results:Amony the 57 cases, 4 had bilateral RLN injury, thus injury occurred in a total of 61 RLNs. TwentySeven RLN injuries occurred on the right side and 34 on the left side. The operation which resulted in RLN injury included 26 thyroid lobectomies(42.6%), 30 subtotal thyroidectomies(49.2%) and 5 thyroid adenoma or cyst enucleation（8.2%）. The RLN injuries were located within 2cm below the point of RLN entering to throat in 49 nerves (80.3%), and at other places in 12 nerves(19.7%). Transection of the nerve was found in 23 nerves (37.7%), and suture or scar pressure of the nerve in 37 nerves（62.3%）. After operative treatment of the RLN injury, 51 cases (89.5%) were followed up for more than 1 year. Among the 51 followed-up patients, phonation was restored to normal or obvious improvement in 49 cases (96.1%), and improvement in 2 (3.9%). Of the 42 patients with 46 RLN injury who underwent indirect or direct laryngoscopy, the affected vocal cord movement completely recovered in 26 vocal cords (56.5%), partially recovered in 8 vocal cords(17.4%), and no recovery was found in 12 vocal cords (26.1%). In all the 4 patients who underwent tracheotomy, the tubes were withdrawn before discharge. There was no relation between the recovery of phonation or vocal cord movement with the timing or the mode of reparative operation.
Conclusions:The location of most RLN injuries caused by thyroid surgery is just below the point of RLN entrance into the throat. Surgical operation is a sure and effective way to deal with RLN injury caused by thyroid operation.

Abstract:Abstract:Objective:To study the application of anatomization of the recurrent laryngeal nerve in thyroid surgery.
Methods :The clinical data of 236 patients who had undergone 335 thyroid operations were retrospectively reviewed. They included: One hundred and one patients (Group A) who had undergone thyroidectomy 158 times without anatomization of the recurrent laryngeal nerve, including 57 of these patients had bilateral thyroid operation; 135 patients (Group B) with anatomization of the recurrent laryngeal nerve who had undergone 177 thyroid operations, including 42 of these patients had bilateral thyroid operations.
Results:All the 4 nerves injury occurred in the region of removal the posterior aspect of thyroid. Temporary nerve injury occurred in one case (0.56%) in Group B, and temporary nerve injury and permanent nerve injury occurred respectively in 2 cases and 1 case (a total injury rate of 1.9%) in Group A. There was a significant difference between the two groups（χ2=0.382, P＜0.01）.
Conclusions:Recurrent laryngeal nerve injury can be safely reduced by dissection of the nerve during thyroid surgery. The recurrent largngeal nerve should routinely be anatomized during removal of the posterior aspect of the thyroid gland.

Abstract:Abstract:Objective:To explore the effect of exposure of the recurrent laryngcal nerve(RLN) in prevention of RLN injury during thyorid surgery.
Methods :The clinical data of 810 cases of thyroid operation in which the RLN was exposed in 252 cases (group A) and was unexposed in 558 cases (group B) were analyzed.
Results:Although the extent of thyroid resection was greater in group A than in group B, the rate of RLN injury in group A (1.19 %) was significantly lower than that of group B (3.05 %,P<0.01).
Conclusions:Selective exposure of RLN during thyroid surgery can significantly decrease the rate of RLN injury.

Abstract:Abstract:Objective:To discuss the proper selection of reoperative method for recurrent nodular goiter to reduce the incidence of major operative complications.
Methods :The clinical data of 68 cases with recurrent nodular goiter treated by operation were retrospectively analyzed. Among them, 56 cases had a single recurrence,10 cases had two recurrences, and 2 cases had three recurrence after the initial operation.
Results:The mean operative time was 136.43min,and the mean operative blood loss was 212.33mL. Unilateral total or neartotal lobectomy and contralateral subtotal or partial lobectomy was performed in 12 cases,unilateral subtotal lobectomy and contralateral subtotal or partial lobectomy was performed in 28 cases,unilateral subtotal lobectomy was performed in 20 cases,and unilateral partial lobectomy was performed in 8 cases.The recurrent laryngeal nerves were exposed in 54 cases of the 68 cases. After reoperation,one patient had paralysis of bilateral vocal cords,and tracheotomy was done;in another case, the left recurrent larynageal nerve was injured.Four patients had transient numbness of extrementies.
Conclusions:The reoperation of choice for recurrent thyroid nodular goiter is unilateral total lobectomy or at least subtotal or nearly total lobectomy, and the partial resection operation should be abandoned.

Abstract:Abstract:Objective:To investigate the factors that influence the prognosis of differentiated thyroid carcinoma(DTC).
Methods :Retrospective analysis the clinical data of 429 cases of DTC treated in our hospital in 9 years was done, and monoand multifactorial analyses related to the prognosis of DTC were performed.
Results:The overall 5, 10year survival rates were 95.2% and 88.7% respectively. Monofactorial analysis showed that age, tumor size, T stage, distantmetastasis, treatment modallty, recurrence, and clinicopathologic stage were prognostic factors (P<0.05); gender, pathological type, and lymph node metastasis had no significantce (P>0.05). Cox multifactorial analysis showed that the T stage, treatment modality and clinicopathologic stage were independent prognostic factors of DTC(P<0.05).
Conclusions:Age, tumor size, T stage, distantmetastasis, treatment modality, recurrence, and clinicopathologic stage were main prognostic factors, and T stage, treatment modality and clinicopathological stage were independent prognostic factors of DTC.

Abstract:Abstract:Objective:To study the choice of initial operative approach for thyroid nodule and the necessity of reoperation after local excision of differentiated thyroid cancer.
Methods :Clinical data of 138 patients with differentiated thyroid cancer after local tumor excision had reoperation at our hospital during a period of four year were retrospectively reviewed. All the reoperations were bilateral thyroidectomy and cervical lymph node excision.
Results:There were 76.8% patients with residual cancer in thyroid and cervical lymph node.There were 23 patients (16.7%) with recurrent laryngeal nerve injury that included 22 cases with unilateral and 1 case with bilateral injury after the initial operation, and 19 of the 23 patients with recurrent laryngeal nerve injury recovered after nerve repair.After thyroid reoperation, 3 cases(2.2%) had recurrent laryngeal nerve injury, 2 cases(1.4%) had partial parathyroid gland injury,2 cases(1.4%) had superior laryngeal nerve injury,but there were no cases of esophageal injury or postoperative bleeding.
Conclusions:The incidence of residual cancer is high after local excision for differentiated thyroid cancer, therefore, reoperation with bilateral thyroidectomy and cervical lymph node excision is necessary.

Abstract:Abstract:Objective:To summaize our experience in surgical treatment of differentiated thyroid carcinoma(DTC).
Methods :The clinical data and followup results of 110 cases of DTC were retrospectively analysed.
Results:All of the 110 patients received operation and TSH suppression therapy. Histologic examination after operation revealed papillary thyroid carcinoma(PTC) in 88 cases(80%), follicular thyroid carcinoma in 22 cases(20%), and cervical lymph node metastasis was found in 22 cases(20%). The operative procedure included excision of the affected lobe, isthmus and greater part of the opposite lobe in 51 cases (along with functional cervical dissection in 12 cases); excision of the affected lobe, and isthmus in 29 cases (along with functional cervical dissection in 7 cases); excision of the affected lobe, isthmus and greater part of the opposite lobe in 18 cases (along with functional cervical dissection in 5 cases); total thyroidectomy and bilateral cervical dissection in 2 cases; total thyroidectomy and bilateral cervical dissection with postoperative 131I therapy in 1 case who had lung metastasis. Following up of 98 cases showed the 10year survival rate was 91.8%.
Conclusions:Differentiated thyroid carcinoma has a good prognosis. Proper selection of surgical procedure is the key point for a good outcome.

Abstract:Abstract:Objective:To investigate the value of clinical application of mammotome under ultrasonic guidance for minimal excision and biopsy of breast tumor.
Methods :Excision and biopsy of 152 breast masses from 115 patients were performed using mammatome under ultrasonic guidance, and the patients were followed up.
Results:Total resection of 152 breast tumors were accurately performed by mammotome vacuum device and biopsy was performed. On pathological examination, 86 cases were fibroadenoma,34 cases were adenosis, 2 cases were fat necrosis ,3 cases were gynecomastia, 1 case was ductal inflammatory change and 26 cases were breast cancer. Postoperatively, hematoma was found in 3 cases，subcutaneous ecchymosis in 4 cases and skin injury in one case. All cases were followed up for a period of time and no residual or recurrent masses were found.
Conclusions:Mammotome vacuum system is an exact, effective and safe method. It is an ideal minimally invasive operation in treating benign breast masses with few complications. It can also be applied to biopsy for breast cancer before operation.

Abstract:Abstract:Objective:To evaluate the feasibility and value of clinical application of ultrasoundguided mammotome minimally invasive system in the diagnosis and treatment of breast abscess.
Methods : From January 2004 to January 2007,53 cases of breast abscess were treated by mammotome minimally invasive system. A suitable covert breast incision was made. The ultrasoundguided mammotome system was used for suction of pus, excision of abscess wall and insertion of drainage tube.The cases with nipple retracion underwent secondstage plastic operation.
Results:All of the 53 cases of breast abscess were cured.The average length of incision was 0.3cm. The average duration of operation was 47.3min. The surgical trauma was small, the course of illness was short, and the cosmetic appearance of the breasts was satisfactory. The clinical diagnosis was confirmed by routine pathology examination.Healing by first intention occurred in 48 cases, and partial nipple surface was scabbed in 5 cases, but all recovered after 2 weeks of conservative therapy.
Conclusions:Mammotone is a feasible and safe procedure with satisfactory cosmetic results for breast abscess. It can provide favorable condition for subsequent plastic nipple surgery.

Abstract:Abstract:Objective:To evaluate the value of breast fiberoptic ductoscopy（FDS）in diagnosis and treatment of intraductal lesions.
Methods :The clinical data of 548 patients with nipple discharge who underwent FDS from Sep 2004 to Nov 2006 were retrospectively analyzed.
Results:Of 548 patients with nipple discharge, the FDS diagnosis was galactophoritis in 59 cases, ductal ectasia in 117 cases, ductal ectasia coexistent with galactophoritis in 185 cases, intraductal papilloma in 159 cases, intraductal papillomatosis in 12 cases and breast carcinoma in 16 cases.One hundred and thirty-five cases had surgical therapy in our hospital,among them,91 cases had tumor resection or segmentectomy under localization by FDS, and 44 cases had segmentectomy after breast duct infusion with methylene blue. The diagnostic conformity rate of FDS localization group（97.8%）was significantly higher than that of breast duct infusion of methylene blue group（86.4%）(P<0.01).
Conclusions:FDS is not only a reliable method of diagnosis for patients with breast intraductal lesion, but can assist in localization and in operative removal of breast intraductal neoplasm. The localization by FDS can avoid blindness of operation and help to improve the detection of intraductal lesions.

Abstract:Abstract:Objective:To investigate the combining anticancer effect of tamoxifen (TAM) and γ-interferon on breast cancer cells in vitro and its mechanism.
Methods :MCF-7 ER-positive breast cancer cell lines were treated with tamoxifen alone, or in combination with γ-interferon and/or estrogen in vitro. Cell proliferation was evaluated by MTT assay; FCM was used to determine the distribution of cell cycle,cell apoptosis and protein expression of Bcl-2,Bax,Fas,FasL,Caspase-8,and the activity of Caspase-3.
Results:TAM inhibited the proliferation of ER-postive breast cancer cells with cell cycle arrest in G0/G1 phase and with induction of apoptosis,and the proliferation-promoting effect of estrogen on MCF-7 was blocked by TAM. Anticancer effect of TAM was enhanced when cells were pretreated with γ-interferon for 24 hours. Bcl-2 protein expression was down-regulated and Caspase-8 was up-regulated by TAM and/or γ-interferon, but these drugs did not affect Bax,Fas,FasL protein expression and the activity of Caspase-3.
Conclusions:TAM has anticancer effect by inhibiting proliferation and inducing apoptosis in ER-positive breast cancer cells in vitro, and γ-interferon can enhance anticancer effect of TAM on breast cancer cells. The mechanism of these effects may be related with the down-regulation of Bcl-2 expression and up-regulation of Caspase-8 by TAM and γ-interferon.

Abstract:Abstract:Objective:To investigate the role of cytochrome C in the apoptosis of hepatoma cell induced by flurouracil , and to analyze the distribution of cytochrome C in cytosol and the relationship between the cytochrome C distribution and Caspase-9 activation.
Methods :The human hepatoma HepG2 cells were treated with flurouracil at 1×10-2mol/L and 2,4,8,16,24h respectively. The chang of cytochrome C in HepG2 apoptosis was detected by using Fluorescent Assay Kit; and proteolytic cleavage of caspase-9 and distribution of cytochrome C in cytosol or in mitochondria was analyzed by Western blot.
Results:Four hours after cells exposure to flurouracil, the caspase-9 activity in HepG2 cells increased gradually and reached the peak at 16h, compared with the control groups, the difference was significant (P<0.01). In Western blot analysis, caspase-9 was found to be cleaved into 10 kD fragment, and distribution of cytochrome C in cytosol became more and more obvious from 4h on and reached a peak at 16h，but the distribution of cytochrome C in mitochondria was opposite. The distribution change of cytochrome C and activity alteration of Caspase-9 were synchronous.
Conclusions:Caspase-9 was activated in the apoptosis of HepG2 cells induced by flurouracil, accompanied by release of cytochrome C from mitochondria to cytosol. This data implies that cytochrome C plays an important role in the activation of Caspase-9 and apoptosis of hepatoma cell induced by flurouracil.

Abstract:Abstract:Objective:To study the clinical outcome of breast conserving treatment of breast ductal carcinoma in situ(DCIS).
Methods :The data of 62 patients with pathologically proven DCIS who underwent breast conserving operation and adjuvant radiotherapy were retrospectively compared with 62 concurrent cases of stageⅠ or Ⅱ infiltrating ducatl carcinoma who received breast conserving operation and adjuvant readotherapy.
Results:The recurrence rate in DCIS cases was 6.4%(4/62), among them, 3 cases belonged to comedo type;the recurrence rate in early infiltrating type of ductal breast carcinoma was 19.3%(11/62)(P<0.05).
Conclusions:In cases of breast ductal carcinoma in situ, breast conserving treatment has better prognosis than early infiltrating ductal carcinoma. The comedo type has a high risk to recur.

Abstract:Abstract:Objective:To explore the diagnosis, treatment and prognosis of male breast cancer.
Methods :The clinical data of 17 male patients with breast cancer were analyzed retrospectively.
Results:The average age of these 17 patients was 59.6 years. In these 17 male cases, the breast cancer in 3 cases was stageⅠ, in 5 cases stageⅡ,in 7 cases stage Ⅲ, and in 2 cases stage Ⅳ. The major pathological type was typical invasive ductal carcinoma. The breast cancer positive rates of estrogen receptor was 82.4 % and progestogen receptor (PR) was 72.5 %. All of these cases were treated by radical operation and postoperative adjuvant radiotherapy, endocrine therapy and (or) chemotherapy. One patient was lost to follow-up, 2 died of non-tumor disease 8 months and 3 years after operation, respectively, and the other 14 have survived for 1-12 years after operation.
Conclusions:Male breast cancer is an uncommon disease, age of onset is more advanced, and the misdiagnostic rate is high. Tamoxifen is the first choice of hormone therapy. Many factors influence the prognosis of male breast cancer, the most important of which are the TNM stage of tumor, and condition of lymph node involvement.

Abstract:Abstract:Objective:
To evaluate the effect of preserving the intercostobrachial nerve(ICBN) during modified radical mastectomy for breast cancer. Methods:Preservation of ICBN during modified radical mastectomy was performed in 100 patients with stage Ⅰ or stage Ⅱ breast carcinoma. All patients were followed up after operation.
Results:Ninty-one patients had normal sensation of the skin of upper arm on operated side, while medial side paresthesia of the upper arm occurred in 9 cases within the postoperative follow up period.
Conclusions:Preserving the intercostobrachial nerve in modified radical mastectomy for patients with breast cancer can decrease the incidence of abnormal sensation of the skin of affected upper arm,and improve the quality of life of patients after operation.

Abstract:Abstract:Objective:To explore the cause and prevention of skin flap necrosis after radical operation for breast cancer and reduce the incidence of skin flap necrosis.
Methods :The data of 158 patients with breast cancer who had surgical treatment were analysed. The data included the thickness of the skin flap, tension of the skin flap, and the mode of the operation and their relation with necrosis of the skin flap.
Results:Among the 158 operated cases, 32 cases (20.25%) had skin flap necrosis. The incidence of the flap necrosis in the thick skin flap group was lower than in the thin skin flap group (10.87%vs28.95%,P<0.05). In the thick skin flap group, the incidence of the flap necrosis in the high tension flap group was higher than in the low tension group (21.43%vs2.00%,P<0.05). In the thin flap group, there was no significant difference between high tension group and low tension group.
Conclusions:The results suggest that the key in prevention of skin flap necrosis is proper thickness of skin flap，perfect suture without tension，prevention of axillary lymphatic leakage and single porous tubular drainage.

Abstract:Abstract:Objective:To investigate the diagnosis and treatment for tuberculosis of the breast.
Methods :Retrospectively analyzed the clinical data of 78 patients with tuberculosis of the breast treated in our hospital in the past 21 years was made.
Results:The incidence of tuberculosis of the breast has been increasing year by year, peasants of remote mountain areas and civilian workers in the cities were the high affected groups. Misdiagnosis rate was as high as 62.9 %. Operation combined with other therapies, and selection of opportune time for operation can reduce the extent of resection, and satisfy the demands of young female patients for high quality of life.
Conclusions:Clinical doctors should improve their recognition of tuberculosis of the breast, increase the rate of correct diagnosis, and avoid missed diagnosis and misdiagnosis, especially misdiagnosis of tuberculosis for breast cancer, which can cause the patients to undergo unnecessary pain and economic burden.