Abstract:摘要:
手术是公认治疗甲状腺癌的最佳选择，但对甲状腺的切除范围及是否常规施行颈淋巴结清扫一直存在争论。笔者结合自己的经验，就甲状腺癌的手术切除范围，颈淋巴结清扫、以及术后综合治疗等相关问题进行了阐述。供同道理们的参考。

Abstract:Abstract:Objective To investigate the cause and treatment of delayedonsef hoarseness after thyroidecomy.
Methods The clinical data of 3180 cases of thyroid disease treated by surgery in our department between 1995~2005 and the 102 cases(3.2%) who developed postoperative delayedonset hoarseness were analyzed respectively.
Results The complication rate of postoperative delayedonset hoarseness for thyroid carcinoma was 5.1%, which was obviously higher than that of benign thyroid disease (2.9%)(P<0.05). The rate in patients in whom the inferior thyroid arteries were ligated intracapsularly and the posterior thyroid capsule was retained (2.3%) was significantly lower than that in patients with extracapsular ligation of the arteries and the posterior capsule was not retained (4.8%, P<0.05). The complication rate in reoperative patients (6.5%) was markedly higher than that in patients who underwent primary operation (3.0 %)(P<0.05). However, there was no difference between the cases in which the recurrent laryngeal nerves were exposed and those in which the nevers were not exposed(P>0.05). In all of the patients with delayedonset hoarseness, ultrasonographic exammation showed various degrees of fluid accumulation in the operative field. Seventyfive of 77 cases(97.4%) with this complication were cured with combined theropy, which was significantly higher than the recovery rate of those cases without treatment(84.0%)(P<0.05).
Conclusions Adequate drainage plays an important role in preventing delayedonset hoarseness. Applying aggressive combined therapy is the key point to cure this complication.

Abstract:Abstract:Objective To explore the relation of recurrent laryngeal nerve damage with the mode of surgery and exposure of the nerve in thyroidectomies.
Methods We retrospectively reviewed the clinical data of 2142 thyroidectomy patients. There were 540 unilateral and 1602 bilateral procedures with 3744 nerves at risk of injury. Among them, 1986 nerves Results The overall incidence of recurrent laryngeal nerve injury was 0.93%(20/2142), and with an incidence of 0.37%（8/2142）for permanent damage. The injury incidence in the nerves exposure and nonexposure groups was 0.30% and 0.80%, respectively, the difference was significant between the two groups(P<0.05). The injury rate of nerves at risk for partial lobectomy, subtotal lobectomy, lobectomy and lobectomy plus ipsolateral neck dissection was increased in that order, and the incidence was higher in nonexposure group than in exposure group, but with no statistical significance(P>0.05).
Conclusions The occurrence of recurrent laryngel nerve injury can be reduced or avoided by its careful exposure and identification during thyroid operation.

Abstract:Abstract:Objective To improve the diagnosis and treatment of primary thyroid lymphoma (PTL). Methods The clinical data of 14 cases of PTL treated from 1990 to 2005 were analyzed retrospectively. Results Twelve cases complained of cervical mass，and 2 cases of hoarseness, with symptoms ranging from 2 weeks to 4 years. Total thyroidectomy of affected side and partial thyroidectomy of the other side was performed in 9 cases, bilateral total thyroidectomy was performed in 3 cases, and simple total thyroidectomy of affected side was performed in 2 cases. There were 9 cases of diffuse large Bcell lymphoma, 4 cases of follicular lymphoma, and 1 case of malignant lymphoblastic lymphoma. After operation, 7 cases underwent combined treatment with radiotherapy and chemotherapy, 4 cases with simple radiotherapy, and 3 cases without any therapy after operation. Thirteen cases(92.8%) were followed up, 1 cases of lymphoblastic lymphoma died 10 months after operationa and 2 cases without postoperative therapy died of metastasis at 18 and 31 months after operation, respectively. The other 10 cases had median followup of 43.2 months(6~122 months), and all of them are in good health. Conclusions PTL is difficult to be diagnosed before operation. Surgical resection is an effective treatment for PTL. The prognostic factors of PTL are associated with pathologic type and comprehensive treatment. It is important for PTL cases to have chemotherapy after operation.

Abstract:Abstract:Objective
To study the clinical characteristics of thyroid carcinoma in young females, in order to improve the diagnosis and treatment of this disease.
Methods The clinical data of 74 consecutive young female patients with thyroid carcinoma treated in our hospital in the recent ten years were analysed. In most of the cases,there was no firm texture or fixation of the thyroid nodules to surrounding structures on physical examination before operation. Ultrasonography was performed in all patients and multiple thyroid nodules were found in 61 cases(82.43%). Thyroid scintiscans were performed in 43 cases, and thyroid nodules were found in 41 cases. The cold, cool and warm nodules were found in 14,18 and 9 cases, respectively, by scintiscans.Fine needle aspiration biopsy(FNAB) was performed in 11 cases, and in 2 cases were negative,1 case showed abnormal cell,3 cases were suspicious of carcinoma,and 5 cases were confirmed papillary carcinoma. Results Papillary carcinoma was found in 70 cases, follicular carcinoma in 3 cases and medullary carcinoma in 1 case by histological examination,and benign disease was also accompanied in most cases. Lymph node metastases was found in 28 cases(37.84%),and the rate of metastases was significantly different than that of older female patients(16.46%) at the same time.There were 2 cases who died 3 years after operation because of metastases.
Conclusions The lymph node metastases were prevalent in young female patients with thyroid carcinoma. The texture and mobility of the nodules cannot be used to differentiate benign from malignant nodules.We should carefully analyze every nodule found on ultrasonography. For the solid nodules with diameter larger than 1.0cm, we suggest operation; for the nonsolid nodules with diameter larger than 2.0cm, we prefer scintiscans and FNAB for diagnosis.

Abstract:Abstract:Objective To investigate the diagnostic localization and surgical treatment of primary hyperparathyroidism(pHPT). 〖JP〗
Methods The clinical data of 52 patients who diagnosed as pHPT and underwent parathyroidectomy at Xijing Hospital between January, 1990 and June, 2005 were retrospectively reviewed.
Results Preoperative ultrasound and Xray examination were performed in all patients, 99m TCMIBI imaging were used in 36 patients and 52 patients using the intraoperative Vital blue technique for operative localization. Pathological bone fractures occurred in 18 cases. Skeletal manifestations were found in 22 cases and urinary stones in 6 cases. Six patients were asymptomatic. Hypercalcemia was detected in all patients with the average value of (3.0±0.5) mmol/L, ranging from 2.7 to 4.3 mmol/L. Thirtyeight patients 〖JP+1〗showed elevated parathyroid hormone (PHT) with the average value of（628.3±87.6）pg/mL, ranging

Abstract:Abstract:Objective
To evaluate the clinical application of endoscopic thyroidectomy(ESTC) via the approach of areola of breast.
Methods The clinical data of 46 cases of endoscopic thyroidectomy via the breast areola approach from October 2004 to November 2006 were retrospectively analyzed.
Results The operation was successfully completed endoscopically in 44 cases,including 18 cases of unilateral partial thyroidectomy,26 cases of bilateral partial thyroidectomy, and 2 cases were converted to open operation for thyroid cancer neck dissection.The operation time of ESTC was 80~160minutes(mean 110min),and the intraoperative blood loss was 25~45ml,(mean,33±9.5ml). Pathological findings showed 25 cases of thyroid adenoma ,16 cases of nodular goiter,and 3 cases of Graves disease. The length of postoperative hospital stay was 3~6day(mean4.5d).Complications occurred in 2 cases, including 1case of bleeding from left puncture tract,and 1 case of temporary hoarseness.
Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure, and has the advantage of minimal trauma,and with excellent cosmetic outcomes.

Abstract:Abstract:Objective
To analyse the difficulties encountered in endoscopic thyroidectomy (ESTC) and discuss their countermeasures.
Methods The clinical data of endoscopic thyroidectomy via anterior chest wall approach in 46 cases performed in our hospital over the last year and a half were summarized.
Results ESTC in 44 cases were successful,and 2 were converted to open operation. The operation time of ESTC was from 86 min to 190 min(mean 126.2±27.0 min). One case had a small area of ecchymosis in the presternal skin postoperativelu. No injury of recurrent laryngeal nerves, hemorrhage or parathyroid injury occurred. There was no scar on the neck after operation.
Conclusions Endoscopic thyroidectomy is safe, and avoids the shortcoming of leaving a scar on the neck that is present after traditional surgical removal of the thyroid gland. No adverse cosmetic effect was observed.

Abstract:Abstract:Objective To study the clinical effect of neoadjuvant chemotherapy(NAC) on advanced breast cancer.
Methods The CAF neoadjuvant chemotherapy ［CTX500mg/m2(1st day ，8th day)，5FUmg/m2(1st day，8th day)，and ADM 30mg/m2(1st day) every 3 weeks)］was carried out in 66 advanced breast cancer patients for 2 cycles before operation，and compared with 58 concurrent operable patients with advanced cancer, who did not receive any preoperative therapy.
Results The overall response rate was 86.36%(57/66) in NAC group. The stages of 41 of the 66 patients(62.12%) was downgraded.The disease free survival time of the patients was 57.6 months which was obviously longer than that of patients without neoadjuvant chemotherapy (42.20 months，p<0.05).〖JP2〗The 5year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 37.89% which was a little higher than that(34.48%)of the patients without the chemotherapy, but the two groups had no significant difference.
Conclusions Neoadjuvant chemotherapy can downgrade the stage of patients with advanced breast cancer，provide an optimal time for operation, obviously prolong the diseasefree survival time of the patients，and reduce or delay recurrence or metastasis.

Abstract:Abstract:Objective To explore the cause of tumor recurrence to internal mammary lymph nodes(IMLN) after breast cancer operation，and emphasize the therapeutic significance of IMLN in breast cancer therapy.
Methods The clinical data of forty female patients with IMLN recurrence after operation were collected and analyzed retrospectively. The data included previous symptoms, operative procedures, pathology staging as well as postoperative treatments.
Results The recurrence of IMLN of 40 patients was not correlated with patient age, menstruation, or operating procedures ( P>0.05). However, it was correlated with primary tumor diameter and location, number of positive axillary lymph nodes, and clinical pathology staging (P<0.05) . 
Conclusions The IMLN metastasis rate is high in the patients with large lesions (>3cm) of inner or central breast regions, more than 3 positive axillary nodes, and advanced clinical pathology staging(IIb+IIIa,b). Comprehensive therapy should be enforced in the patients with the high risk factors of recurrence.

Abstract:Abstract:Objective To investigate the clinical characteristics, diagnosis and treatment of patients with carcinomatous change of breast intraductal papillomas(IP).
Methods The clinical and pathologic data of 22 patients treated from Jan 2000 to Jan 2005 were analyzed restrospectively.
Results The 22 patients accounted for 4.61%(22/477) of patients with IP and 5.96%(22/369) of patients with breast cancer during the same period. Tweenty of the 22 patients did not have biopsy, and a definite diagnosis was not made before operation. Frozen section established the diagnosis in 13 of the 20 cases, but was negative in 7 cases. In this series, 2 cases received segmental mastectomy, 16 cases received total mastectomy, and 4 cases received modified radical mastectomy (the postoperative pathology confirmed that no axillary node metastasis was found).
Conclusions It is difficult to diagnose the carcinomatous change of breast intraductal papillomas before operation, because there are no spelific clinical characteristics, and frozen section is considerable to confirm the diagnosis, and the treatment of choice is simple mastectomy.

Abstract:Abstract:Objective To exploration the selection of the best incision for operative treatment of benign breast tumor.
Methods The clinical data of 548 cases of benign breast tumor operated by periareolar incision were retrospectively anlyzed.
Results All patients underwent tumor resection and were satisfied with the incision.
Conclusions Benign breast tumor can be excised through periareolar incision, and not leave behind an obvious scar, so it can satisfy the cosmetic requirement of many patients.

Abstract:Abstract:Objective To study the micrometastasis in peripheral blood, lymph node and bone marrow in patients with breast cancer and the effect of adjuvant chemotherapy on bone marrow micrometastasis.
Methods RTPCR technique was used to simultaneously detect the micrometastasis in peripheral blood, lymph node and bone marrow in 69 patients with operable breast cancer, and the effect of adjuvant chemotherapy on bone marrow micrometastasis was also investigated.
Results The positivity of bone marrow micrometastasis tested by RTPCR in breast cancer patients was 34.8%. The circulating tumor cells were found in 11 patients (15.9%). Lymph node metastasis was positive in 35 cases, out of the 35 nodepositive cases, 32 cases(91.4%) were lymph node micrometastasis, out of the 34 nodenegative cases, eight cases(23.5%) were lymph node micrometastasis. Seven of 24 cases(29.2%) of bone marrow micrometastasis positive patients became negative after receiving six cycles of CAF adjuvant chemotherapy.
Conclusions Detection of CK19mRNA by RTPCR is a sensitive and specific method of assessing micrometastasis in patients with breast cancer. Compared with the detection of bone marrow micrometastasis , the technique to detect the micrometastasis in peripheral blood is less sensitive or specific. The detection of bone marrow micrometastasis is a sensitive index to assess the effect of adjuvant chemotherapy.

Abstract:Abstract:Objective To explore the expression of Galectin3 in thyroid lesions and its value in differentiating benign from malignant lesions.
Methods Galectin3 protein expression in 99 cases of thyroid lesions was studied by streptavidin/peroxidase(SP) immunohistochemistry technique. Results Fiftynine of the 67(88.1%) cases of thyroid carcinomas (22/24 follicular carcinomas, 24/27 papillary carcinomas, 10/12 medullary carcinomas and 3/4 anaplastic carcinomas) showed cytoplasmic immunohistochemical staining of Galectin3, which was diffuse. As to the group of adenomas(n=19), only 3 cases were focally and weakly positive. There was no Galectin3 expression in 13 cases of thyroid papillary hyperplasia. There was significant difference between the expression of Galectin3 in malignant thyroid tumors and that in benign lesions(P<0.01), and no difference between the four histological types of thuroid cnacer(P>0.05). Conclusions Galectin3 may be useful in the diagnosis of thyroid carcinomas, and it can be regarded as a valuable molecular marker to distinguish benign from malignant lesions.

Abstract:Abstract:Objective To investigate the role of βcatenin gene in breast tumorigenesis.
Methods Mutation and expression of βcatenin gene in 42 breast cancer tissues were detected by polymerase chain reactionsingle strand conformation polymorphism and immunohistochemistry.
Results The rate of abnormal expression of βcatenin in breast cancer tissuse was 59.5%（25／42）. Mutation of βcatenin gene was not detected in breast cancer tissue.
Conclusions Abnormal expression of βcatenin plays an important role in human breast tumorigenesis, but the cause of abnormal expression of βcatenin is not mutation of βcatenin gene.

Abstract:Abstract:Objective
To study the expression of BRMS1mRNA in human breast cancer tissues and their significance.
Methods The expression of BRMS1mRNA was detected by reverse transcriptionpolymerase chain reaction(RTPCR) in 71 breast cancer tissues and adjacent breast tissues,12 patients with benign breast tumors and 12 patients with normal breast tissue,and semiquantitative analysis of band densities was also performed.
Results The expression of BRMS1mRNA in 71 patients with breast cancer and adjacent breast tissue was 0.378±0.046 and 0.918±0.044, respectively; the expression of BRMS1mRNA in 12 patients with benign breast tumors and 12 patients with normal breast tissue was 0.908±0.047 and 0.934±0.028 respectively. BRMS1mRNA expression was significantly lower in breast cancer tissue compared to adjacent breast tissue,benign breast tumors and normal breast tissue (P<0.01) .The expression of BRMS1mRNA in breast cancer was reduced and had no relation with patient age,tumor size,and ER,PR (P>0.05), but was related to axillary lymph node metastasis and clinical stage(P<0.05). Conclusions The expression of BRMS1mRNA in patients with breast cancer was correlated with axillary lymph node metastasis and clinical stage, and the reduction of BRMS1mRNA expression could be an index for metastasis and prognosis of patients with breast cancer.

Abstract:Abstract:Objective To investigate the effect of wildtype PTEN gene mediated by adenovirus vector on the cell cycle of human breast cancer cell line MDAMB468 in vitro.
Methods PTEN gene was cloned into pAdTrackCMVPTEN. The newly recombinated pAdPTEN containing green fluorescent protein (GFP) was infected into human breast cancer cell line MDAMB468 in vitro, and the cell cycle was detected by flow cytometric analysis.
Results The recombinant adenovirus vector carrying PTEN was constructed successfully, and the titre of purified adenovirus was 2.5×1010 pfu/mL. Cell number of control group in G1 phase accounted for 41.18%, while the transfected PTEN gene group was 56.47% of G1 cell number as measured by flow cytometry.
Conclusions The recombinant adenovirus vector of PTEN was rapidly constructed successfully using AdEasy1 system. Target genes were successfully transfected and expressed stably. PTEN may cause cell cycle arrest at the G1 phase.

Abstract:Abstract:Objective To study the inhibitory effect of arsenic trioxide(As2O3) on the tumor growth of breast cancer cell line MCF7 implanted subcutaneously in nude mice and its mechanism.
Methods BALB/Cnu/nu nude mice were subcutaneously injected with MCF7 breast cancer cell line, and treated with intraperitoneal injection of As2O3 and 5FU in different concentrations. The implanted tumor was weighed, and the tumor inhibition rates were calculated. The apoptosis of the implanted tumor was detected by flow cytometry. The expressions of bcl2 and Fas induced by As2O3 were examined by immunohistochemical method. Routine blood test and bone marrow test were used to observe the function of hematopoietic system after As2O3 treatment.
Results The growth of implanted tumor was markedly inhibited with 5FU, low dose and high dose As2O3, the inhibitory rates being 38.33%、51.42% and 62.43%,respectively. The inhibitory effect of As2O3 was significantly stronger than that of 5FU(P<0.01). The apoptosis rate of MCF7 cells treated with the 2 concentrations of As2O2 was significantly higher than that of 5FU treated group. Breast cancer cells in all the study groups showed G2/M stage arrest, while a marked apoptosis peak was observed before the G1 peak. The immunohistochemical staining showed that the number of bcl2 protein positive cells decreased, and the number of Fas protein positive cells increased. The function

Abstract:Abstract:Objective
To investigate the expression level of RECK mRNA and MMP9mRNA in breast cancer(BC) and fibroadenoma tissues and its significance.
Methods The mRNA level of tissues of 39 cases of breast cancer and 14 cases of fibroadenoma was measured by RTPCR technique and its correlation was analyzed.
Results The mRNA level of RECK gene in breast cancer tissues was markedly lower than that in fibroadenoma tissues, while the MMP9 level was higher in BC tissues.
Conclusions RECK is a tumor suppressor gene, the expression in benign and malignant breast tissues is a negative relationship. BECK can inhibit the expression of MMP9 and thus, inhibit the growth and metastasis of breast cancer.

Abstract:Abstract:Objective To study the specific killing effect of recombinant expression vector containing human breast cancer DF3 promotor and diphtheria toxin A fragment on human breast cancer cells implanted in vivo. Methods To establish human breast cancer xenograft in nude mice，thirtysix nude mice were divided into four groups at random，nine animals in each group. Human breast cancer cells of DF3 positive and negative（MCF7 and MDAMB231）were inoculated into corresponding animals respectively. Recombinant expression vector PGL3DF3DTA and PGL3DF3 were inoculated into corresponding tumor after if developed in the animals. The tumor weight was measured and calculated continually. The animals were killed at different time periods. The morphological changes were observed. The apoptosis index of cells was evaluated by insitu TUNEL. Immunocytochemical methods were used to detect the expression of Ki67,Bax and Bcl2 protein.
Results Human breast cancer xenograft were established in nude mice successfully. The human breast cancer cells treated by PGL3DF3DTA showed a typical apoptosis morphology and TUNEL detection analysis revealed the apoptosis index of the experimental groups was significantly enhanced，which was associated with time and dosage. The expression of Ki67 and Bcl2 were downregulated, and the expression of Bax was elevated. 〖WTHZ〗Conclusions Recombinant expression vector PGL3DF3DTA could produce specific killing effect on DF3 positive human breast cancer cell line.

Abstract: