一种新型结节定位装置在甲状腺手术的应用

背景与目的:甲状腺结节的发病率逐年升高,手术切除为甲状腺小结节的病理诊断和治疗提供了理想方法,但是对小结节的定位成为手术过程中的一大难题。本研究的目的在于明确一种新型甲状腺结节定位装置在甲状腺手术中的可行性和安全性。方法:在超声引导下,运用该定位装置在术前对有强烈手术意愿的患者进行甲状腺结节精准定位。随后对该项技术进行回顾性研究,以评估该新型定位技术的安全性和可行性。主要结局指标包括探究该项定位技术的安全性(定位过程是否导致出血以及其他不良反应)和成功率(能否精准定位甲状腺微小结节并且将其成功切除);次要结局指标包括可行性(定位过程持续时间以及定位装置是否失败和损坏)。结果:共对29例甲状腺切除手术患者的29个甲状腺微小结节进行术前精准定位。总体而言,28例患者的甲状腺微小结节被成功精准定位并切除,未出现术中定位钩子断裂或者脱落的情况。1例患者出现了结节与定位针钩子之间存在距离偏差,最终扩大切除范围后才将结节切除。其中结节直径大小中位数为0.5 cm,定位过程的时间平均数为13 min。没有病人在手术过程中或术后出现明显的相关并发症。结论:在甲状腺手术中使用该定位装置安全可靠,具有较高的定位成功率,能提高对甲状腺疾病的诊断率,同时也方便临床手术医生操作。是一种具有一定临床应用价值的结节精准定位技术。Background & Objective: The incidence of thyroid nodules is increasing year by year. Surgical resection provides an ideal method for the pathologic diagnosis and treatment of thyroid nodules, but the localization of nodules is a major problem in the surgical process. The objective of this study was to determine the feasibility and safety of a novel thyroid nodule localization device in thyroid surgery. Methods: Under the guidance of ultrasound, the localization device was used to accurately locate thyroid nodules in patients with a strong desire for surgery. Subsequently, a retrospective study was conducted to evaluate the safety and feasibility of this novel positioning technology. Primary outcome measures included examining the safety of the localization technique (whether the localization process resulted in bleeding and other adverse effects) and success rate (whether the tiny thyroid nodules could be accurately located and successfully removed). Secondary outcome measures include feasibility (duration of the positioning process and whether the positioning device fails and is damaged). Results: A total of 29 thyroid micronodules in 29 patients undergoing thyroidectomy were accurately located before the operation. Overall, the thyroid micronodules were successfully located and removed in 28 patients without intraoperative location hook breakage or loss. In 1 patient, there was a distance deviation between the nodules and the positioning needle hook, and the nodules were removed only after the scope of resection was expanded. The median diameter of nodules was 0.5cm. The average time of the positioning process was 13 minutes. None of the patients had significant complications during or after the procedure. Conclusion: The localization device is safe and reliable in thyroid surgery, and has a high localization success rate, which can improve the diagnosis rate of thyroid diseases and facilitate the operation of clinical surgeons. It is an accurate nodule localization technique with a certain clinical application value.

三种评分预测严重烧伤患者死亡风险的对比研究

目的探讨改良Baux评分、比利时烧伤预后评分、Ryan评分对严重烧伤患者死亡风险的预测价值,并进行对比研究。方法采用回顾性病例系列研究方法。2018年2月—2019年11月,南昌大学第一附属医院烧伤科收治260例符合入选标准的严重烧伤患者,其中男158例、女102例,年龄36(3,53)岁。根据最终结局,将患者分为存活组(229例)和死亡组(31例),比较2组患者入院时性别、年龄、烧伤原因、烧伤部位、烧伤总面积、烧伤深度、合并吸入性损伤情况、合并基础疾病情况,以及根据前述部分资料计算的改良Baux评分、比利时烧伤预后评分、Ryan评分,对数据进行χ^(2)检验或Mann-Whitney U检验。采用Kendall tau-b系数法对260例严重烧伤患者前述3种评分结果进行一致性分析。分别绘制前述3种评分预测260例严重烧伤患者死亡风险的受试者操作特征曲线(ROC),计算曲线下面积(AUC)及最佳阈值与最佳阈值下的敏感度、特异度。采用Delong检验对前述3种评分AUC的质量进行比较。结果2组患者性别、烧伤部位、烧伤深度均相近(P>0.05);死亡组患者年龄、烧伤总面积、火焰烧伤比例、合并吸入性损伤比例、合并基础疾病比例均明显大于存活组(Z值分别为5.53、7.18,χ^(2)值分别为16.23、15.89、17.78,P<0.01);死亡组患者改良Baux评分、比利时烧伤预后评分、Ryan评分分别为142(115,155)、7(5,7)、2(2,3)分,均明显高于存活组的64(27,87)、1(0,3)、0(0,1)分(Z值分别为7.91、7.64、7.61,P<0.01)。在260例严重烧伤患者中,改良Baux评分与Ryan评分、改良Baux评分与比利时烧伤预后评分、Ryan评分与比利时烧伤预后评分结果均具有显著一致性(Kendall tau-b系数分别为0.75、0.71、0.86,P<0.01)。改良Baux评分、比利时烧伤预后评分、Ryan评分对260例严重烧伤患者死亡风险预测的ROC的AUC分别为0.92、0.89、0.85(95%置信区间分别为0.86~0.98、0.83~0.95、0.78~0.93,P<0.01),最佳阈值分别为106.5、4.5、1.5分,最佳阈值下的敏感度分别为88.5%、76.9%、73.1%,最佳阈值下的特异度分别为88.5%、87.2%、86.3%。改良Baux评分与比利时烧伤预后评分的AUC质量相近(z=1.25,P>0.05),均明显优于Ryan评分(z值分别为2.35、2.11,P<0.05)。结论改良Baux评分、比利时烧伤预后评分、Ryan评分对严重烧伤患者死亡风险均有较好的预测能力,从临床实践考虑,改良Baux评分更适合作为严重烧伤患者的预后预测工具。