Ultrasound Diagnosis of Cervical Vagal Schwannoma Misdiagnosed as Nodular Goiter

Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diagnosis and treatment of cervical vagal schwannoma and the causes of misdiagnosis and preventive measures. Case Presentation: A case of cervical vagal schwannoma misdiagnosed as nodular goiter by ultrasonography was analyzed retrospectively. This patient was found to have pain in the neck for 1 month and then went to our hospital for treatment. After admission, a 5 cm × 4 cm mass was found on the left side of the neck, with a medium texture and clear margin. It could move with swallowing. Initially ultrasound showed a well circumscribed hypoechoic mass in the left thyroid lobe, which is suggestive of hemorrhage of thyroid nodule. Biopsy of thyroid nodules after ultrasound guided biopsy revealed Schwannoma. Surgical treatment and postoperative pathological examination confirmed cervical vagal schwannoma. The patient recovered well and was discharged 9 days after operation. Conclusion: The location of thyroid schwannoma is rare, the relationship between thyroid schwannoma and surrounding tissues is unclear, and there is no typical ultrasonic manifestation. Moreover, if doctors are not aware of their knowledge, it is easy to cause misdiagnosis. Radiologists should raise awareness of the disease and carefully analyze the results of ultrasonography in combination with the clinical manifestations of the patients so as to reduce or avoid misdiagnosis of cervical schwannoma.

Total Thyroidectomy in Multinodular Goiter: An African Experience

Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complication rates of total thyroidectomy on benign indication and first-time thyroid surgery and investigate the early outcome after opotherapy. Materials and Methods: In this retrospective study, patients who underwent total thyroidectomy for benign multinodular goiter in the department of thoracic surgery in our Hospital from January 2012 to December 2014 were included. In postoperative time, we evaluated surgical complication, histopathological examination and opotherapy. Results: A total 53 patients underwent total thyroidectomy for multmodular goiter;they were 49 (92.45%) bilateral and 4 (7.55%) unilateral (recurrence). The mean age was 47 years and mean diameter of goiter was 10.75 cm. Among the patients 88.68% were females and 11.32% were male. Preoperative hormonal statuses were (70%) in euthyroid and (30%) hyperthyroid following surgery complications like transient laryngeal nerve palsy (3.77%), transient hypocalcemia (7.55%), hematoma (1.9%) and wound infection (1.9%). On histopathological examination of the surgical specimen, 5.7% were reported to be malignant. Six month following surgery 92.45% of patients was a good hormonal balance. Conclusion: Total thyroidectomy for multinodular goiter has a low morbidity and mortality;this procedure olves both the problem of recurrence of disease and reintervention. The opotherapy is doable with a good hormonal balance.

Correlation between thyroid function and nodular goiter accompanied with gallstone

Objective： The purpose of the study wass to explore the correlation between thyroid function and nodular goiter accompanied with gallstone. Methods： We collected 120 cases about nodular goiter accompanied with gallstone and 128 cases about nodular goiter and establish 50 healthy control groups. Detected t level of hyrotropic hormone （TSH）, total triio- dothyronine （TT3）, total thyroxine in the peripheral venous blood of these cases in the three groups by using electrochemilu- minescenca immunoassay, measure level of total cholesterol （TC）, high-density tipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol （LDL-C） and total bile acid （TBA） levels by using enzymic method, and observed the changes of thyroid function and blood lipid among the three groups. Results： The serum TT3 level in nodular goiter accompanied with gallstone group and the nodular goiter group was significantly lower than that in control group （P 〈 0.01）, and TSH level in the nodular goiter accompanied with gallstone group is significantly higher than that in control group （P 〈 0.01）, There were no statistical significance about difference of TT4 level among the three groups （P 〉 0.05）. Accordingly, TC and LDL-C level in nodular goiter accompanied with gallstone group was significantly higher than that in nodular goiter and control group （P 〈 0.01）, while TBA level in nodular goiter accompanied with gallstone group was significantly lower than that in simple nodular goiter group and control group （P 〈 0.01）. There was no statistical significance about difference of TC and LDL-C level between simple nodular goiter group and control group （P 〉 0.05）. The HDL-C level in nodular goiter accompanied with gallstone group and control group was higher than that in simple nodular goiter group （P 〈 0.01）. Conclusion： The originating etiologic factor of nodular goiter accompanied with gallstone may be related to that the decreased TT3 induced sub-clinical hypothyroidism.

Complications of Goitre Surgery in “A” Surgery at the Chu of Point G

Total or partial thyroidectomy has been proposed as the initial treatment for benign euthyroid oiter. The aim of this study is to determine the complications associated with surgical procedures for goiter, based on our experience. Material and method: A retrospective study over 10 years concerning 409 patients operated on for goiters in the department with 48 cases of complications. Results: 409 patients operated on for goiter in the department with 48 cases of complications (11.82%). The per- and post-operative complications were: hemorrhage (18: 4.40%), recurrent lesions (1;0.24%), 8 cases of infection (1.96%), 5 cases of transient hypocalcemia (1.22%) and phonation disorders 9 cases (2.20%). Conclusion: Complications from goiter surgery seem to be more related to thyroid disease and the surgeon’s experience than to the surgical procedure. Better knowledge of the factors leading to complications will improve the outcome of goiter surgery.

Advances in the Intervention of Prunella Spica Capsules on Postoperative Recurrence of Nodular Goiter

As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.

Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review

AIM: To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia(NRH) in patients with human immunodeficiency virus(HIV). METHODS: We performed a systematic review of the medical literature regarding NRH in patients with HIV. Inclusion criteria include reports with biopsy proven NRH. We studied the clinical features of NRH, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: "nodular regenerative hyperplasia", "human immunodeficiency virus", "noncirrhotic portal hypertension", "idiopathic portal hypertension", "cryptogenic liver disease", "highly active antiretroviral therapy" and "didanosine". The bibliographies of these studies were subsequently searched for any additional relevant publications.RESULTS: The clinical presentation of patients with NRH varies from patients being completely asymptomatic to the development of portal hypertension – namely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NRH and the use of antiviral therapies such as didanosine. The management of NRH revolves around treating the manifestations of portal hypertension. The prognosis of NRH is generally good since liver function is preserved. A high index of suspicion is required to make a identify NRH. CONCLUSION: The appropriate management of HIVinfected persons with suspected NRH is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.

早期甲状腺乳头状癌血清代谢组学特征及其与淋巴结转移的关系

目的对比分析T1级甲状腺乳头状癌(PTC)与结节性甲状腺肿(nodular goiter,NG)的代谢组学特征,以及代谢产物与PTC患者淋巴结转移的关系。方法收集2020年1月~2021年12月于民航总医院耳鼻咽喉头颈外科行甲状腺切除术的60例T1级PTC患者和30例NG患者的血清样本。根据有无淋巴结转移,将PTC组分为有淋巴结转移(N+组)和无淋巴结转移(N-组)。使用超高效液相色谱-质谱(UPLC-Q-Exactive-MS)联用平台,分别对N+组与N-组、PTC组与NG组的血清代谢物进行对比分析,使用SIMCA-P 14.1软件进行主成分分析(principal component analysis,PCA)、偏最小二乘判别分析(partial least squares discrimination analysis,PLS-DA)、正交偏最小二乘判别分析(orthogonal partial least squares discriminant analysis,OPLS-DA)并进行建模,结合FDR校正的Mann-Whitney-Wilcoxon检验结果和代谢物在进行对比的两组中的差异倍数等来筛选潜在小分子代谢标志物,并通过二元逻辑回归分析建立联合诊断模型。结果N+组和N-组之间不存在明显差异代谢物。PTC患者与NG患者之间有7个差异性代谢物,相关的5条代谢通路分别为磷酸戊糖途径、戊糖和葡萄糖醛酸相互转化、糖酵解/糖异生、果糖和甘露糖代谢和脂肪酸生物合成。受试者工作特征(ROC)曲线下面积(AUC)>0.9的差异性代谢物为D-甘油醛3-磷酸,另有N-十一烷酰基甘氨酸、尿酸及三碘甲状腺原氨酸葡萄糖醛酸三种代谢物的AUC>0.8。结论PTC与NG患者主要在糖代谢和脂质代谢上有区别,D-甘油醛3-磷酸可以在N-十一烷酰基甘氨酸、尿酸及三碘甲状腺原氨酸葡萄糖醛酸的辅助下,结合影像学检查结果区分PTC与NG患者。同时,N+组和N-组的对比中未发现明显差异血清代谢物,是否存在淋巴结转移不会对T1级PTC患者的血清代谢物产生影响。

消瘿散结方联合左甲状腺素钠片对结节性甲状腺肿甲状腺功能和结节大小的影响

目的观察消瘿散结方联合左甲状腺素钠片对结节性甲状腺肿患者甲状腺功能和结节大小的影响。方法选取2021年7月—2022年7月山西省人民医院中医科收治的100例符合纳入和排除标准的结节性甲状腺肿患者,采用随机数字表法将上述患者均分为两组,其中常规治疗组50例,予以甲状腺素钠片治疗,消瘿散结组50例,在常规治疗组基础上给予消瘿散结方治疗。比较两组患者的临床疗效、甲状腺结节大小和数量变化,以及干预前后的心理状态及不良反应情况。结果常规治疗组的总有效率为80.00%(40/50),消瘿散结组的总有效率为94.00%(47/50),与常规治疗组比较,消瘿散结组的总有效率明显升高(P<0.05)。两组患者干预完成后,消瘿散结组患者的结节大小、数量以及动脉血流参数水平相较于常规治疗组均明显下降(P<0.01)。与常规治疗组比较,消瘿散结组病人的游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)以及促甲状腺激素(TSH)水平在干预前后均无明显变化(P>0.05)。干预前两组患者的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分差异无统计学意义(P>0.05)。干预完成后,消瘿散结组病人的SAS评分、SDS评分水平相较于常规治疗组明显降低(P<0.01)。治疗过程中,两组患者主要不良反应有头痛、心悸、药疹以及恶心呕吐等,常规治疗组的总发生率为18.00%(9/50),消瘿散结组的总发生率为14.00%(7/50),与常规治疗组比较,消瘿散结组的不良反应总发生率差异无统计学意义(P>0.05)。结论左甲状腺素钠片联合消瘿散结方能够提高结节性甲状腺肿(气郁痰凝型)的临床疗效,改善甲状腺功能,减少结节数量、缩小结节体积,其疗效优于单纯左甲状腺素钠治疗,适宜临床推广。

碘-131放射性核素治疗结节性甲状腺肿伴甲状腺功能亢进的临床效果

目的 探究对结节性甲状腺肿伴甲状腺功能亢进患者实施碘-131放射性核素治疗的作用。方法 本次研究中选取自2020年1月至2022年12月到汕头市中心医院就诊的86例结节性甲状腺肿伴甲状腺功能亢进患者。以随机抽签法均分为碘-131组与常规组,两组均为43例。常规组行常规治疗方案。碘-131组采用碘-131放射性核素治疗。比较两组的治疗效果、甲状腺功能及不良反应发生情况。结果 碘-131组治疗效果高于常规组,差异有统计学意义(P<0.05);碘-131组甲状腺功能中游离甲状腺素(FT4)及游离三碘甲状腺原氨酸(FT3)水平均低于常规组,差异有统计学意义(P<0.05);碘-131组甲状腺功能中促甲状腺激素(TSH)水平高于常规组,差异有统计学意义(P<0.05);碘-131组不良反应情况低于常规组,差异有统计学意义(P<0.05)。结论 对结节性甲状腺肿伴甲状腺功能亢进患者实施碘-131放射性核素治疗的效果较好,甲状腺功能改善明显,安全性较高。

S100A6联合应用在分化型甲状腺癌及良性甲状腺病变中的诊断价值

目的 探讨S100A6联合CK19、Galectin-3和P27在DTC及良性甲状腺病变中的诊断价值。方法 选取2020-07月——2023-03于承德市中心医院经术后病理确诊为DTC的119例患者,包括PTC96例,FTC23例;另选78例良性患者作为对照组。通过IHC检测四种蛋白在甲状腺病变中的表达,分析S100A6蛋白联合应用的诊断效果。结果 S100A6、CK19、Galectin-3和P27在恶性组中阳性表达率为85.7%、94.1%、89.1%、45.4%,在良性组中阳性表达率为17.9%、16.7%、35.9%、83.3%。四种标志物在各组间表达有显著差异,差异有统计学意义(P<0.05)。S100A6(+)、CK19(+)、P27(-)是TC的影响因素(P<0.05),S100A6联合检测时达到最大(S100A6/CK19/P27)AUC=0.974,敏感度97.4%,特异度92.4%。结论 S100A6蛋白联合应用较单独应用时诊断效能提高,敏感度及特异度增加,对DTC鉴别诊断作用明显增强,推荐S100A6与CK19及P27联合应用。

平消胶囊联合左甲状腺素钠治疗结节性甲状腺肿的效果

目的分析平消胶囊联合左甲状腺素钠治疗结节性甲状腺肿的效果。方法于2020年3月至2022年9月在南阳市中心医院收集病例展开研究,将92例结节性甲状腺肿患者按随机数字表法分为联合组(46例)与单一组(46例)。单一组接受左甲状腺素钠治疗,联合组加用平消胶囊。对比两组疗效;对比两组治疗前后甲状腺激素水平[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)]、结节最大直径、血管内皮生长因子(VEGF)水平、转化生长因子-β_(1)水平(TGF-β_(1))、白细胞介素-1β(IL-1β)水平、白细胞介素-6(IL-6)水平;对比两组不良反应发生率。结果联合组患者总有效率[95.65%(44/46)]较单一组患者[80.43%(37/46)]高(P<0.05)。与治疗前比,两组患者治疗后FT_(3)、FT_(4)均升高,TSH均降低(P<0.05);与单一组患者治疗后比,联合组患者FT_(3)、FT_(4)较高,TSH较低(P<0.05)。与治疗前比,两组患者治疗后结节最大直径均缩短(P<0.05);与单一组患者治疗后比,联合组患者结节最大直径较短(P<0.05)。与治疗前比,两组患者治疗后VEGF均降低,TGF-β_(1)均升高(P<0.05);与单一组患者治疗后比,联合组患者VEGF较低,TGF-β_(1)较高(P<0.05)。与治疗前比,两组患者治疗后IL-1β、IL-6水平均增高(P<0.05);与单一组患者治疗后比,联合组患者IL-1β、IL-6水平较高(P<0.05)。联合组患者不良反应发生率[6.52%(3/46)]与单一组患者[4.35%(2/46)]对比,差异无统计学意义(P>0.05)。结论平消胶囊联合左甲状腺素钠治疗结节性甲状腺肿效果确切,可调节VEGF、TGF-β_(1),能缩小结节,改善甲状腺功能,且安全性良好。

超声检查对甲状腺癌与结节性甲状腺肿的鉴别诊断价值分析

目的 探讨超声检查对甲状腺癌与结节性甲状腺肿的鉴别诊断价值。方法 200例甲状腺疾病作为研究对象,将100例甲状腺癌患者作为甲状腺癌组,100例结节性甲状腺肿患者作为结节性甲状腺肿组。两组患者均采用超声检查。分析超声检查的敏感性、特异性、准确性;比较两组患者结节超声表现、检查满意度。结果 超声检查鉴别诊断甲状腺癌与结节性甲状腺肿的敏感性为95.0%(95/100),特异性为97.0%(97/100),准确性为96.0%(194/200)。甲状腺癌组结节低回声95个、高回声23个、混合回声6个,结节性甲状腺肿组结节低回声7个、高回声53个、混合回声113个;甲状腺癌组结节血流分级Ⅰ级30个,Ⅱ~Ⅲ级94个,结节性甲状腺肿组结节血流分级Ⅰ级157个,Ⅱ~Ⅲ级16个;甲状腺癌组结节边缘清晰26个,模糊98个,结节性甲状腺肿组结节边缘清晰130个,模糊43个;甲状腺癌组结节有钙化97个,无钙化27个,结节性甲状腺肿组结节有钙化18个,无钙化155个。两组患者结节回声、血流分级、边缘及钙化情况比较差异具有统计学意义(P<0.05)。甲状腺癌组患者检查满意度95.0%与结节性甲状腺肿组的98.0%差异无统计学意义(P>0.05)。结论 超声鉴别诊断甲状腺癌与结节性甲状腺肿临床价值显著,可为患者开展治疗提供准确可靠的依据,值得在临床上推广应用。

超声检查联合CT诊断结节性甲状腺肿合并甲状腺癌的符合率分析

目的探析超声联合CT检查在结节性甲状腺肿合并甲状腺癌患者诊断中的诊断价值。方法选取2022年1月—2023年12月高唐县中医院收治的80例疑似甲状腺癌患者为研究对象,所有入组患者均行超声检查、CT检查,以病理检查结果作为金标准,对比两种检验方式的单一及联合诊断效能与诊断符合率。结果联合诊断的灵敏度为91.80%(56/61)、特异度为94.74%(18/19)、准确度为92.50%(74/80)、阳性预测值为98.25%(56/57)、阴性预测值为78.26%(18/23),均高于超声检查的68.85%(42/61)、63.16%(12/19)、67.50%(54/80)、85.71%(42/49)、38.71%(12/31)与CT检查的77.05%(47/61)、57.89%(11/19)、72.50%(58/80)、85.45%(47/55)、44.00%(11/25),差异有统计学意义(χ^(2)=17.487、7.473、16.057、6.605、9.188,P均<0.05)。联合诊断对乳腺状癌、滤泡癌的的诊断符合率高于单一超声及CT检查,差异有统计学意义(P均<0.05)。不同检查方式对滤泡癌、髓样癌、未分化癌的诊断符合率比较,差异无统计学意义(P均>0.05)。结论超声与CT联合诊断结节性甲状腺肿合并甲状腺癌的诊断效能较高,均可为后续诊治提供一定参考依据。

超声检查对结节性甲状腺肿及甲状腺腺瘤患者的诊断价值

目的探讨超声检查对结节性甲状腺肿及甲状腺腺瘤患者的临床诊断价值。方法选取2021年1-12月宜春市人民医院收治的96例结节性甲状腺肿或甲状腺腺瘤患者作为研究对象,均行超声检查,以手术病理检查为金标准,并根据金标准结果分为结节性甲状腺肿组(n=36)和甲状腺腺瘤组(n=60)。比较两组超声检查检出符合率、超声影像特征、结节周边和结节内部超声血流信号检出情况及血流参数。结果两组超声检出符合率比较差异无统计学意义。甲状腺腺瘤组结节的包膜、晕环及单发结节比例均高于结节性甲状腺肿组,差异有统计学意义(P<0.05),两组钙化、结节内回声、结节大小、甲状腺大小情况比较差异无统计学意义。甲状腺腺瘤组结节周边和结节内部超声血流信号级别均高于结节性甲状腺肿组,差异有统计学意义(P<0.05)。甲状腺腺瘤组结节周边RI低于结节性甲状腺肿组,V_(min)和V_(max)均快于结节性甲状腺肿组,差异有统计学意义(P<0.05),但两组结节内部RI及V_(min)、V_(max)比较差异无统计学意义。结论超声检查用于结节性甲状腺肿和甲状腺腺瘤患者的临床诊断中,不仅可获得清晰的图像,提高检出率,还能为疾病的鉴别诊断提供一定参考依据。

黄仰模辨治结节性甲状腺肿思路探讨

结节性甲状腺肿归属于中医“瘿病”范畴。黄仰模教授认为,情志不调为结节性甲状腺肿的主要致病因素,病症表现与肝经循行部位相应,故提出结节性甲状腺肿的治疗需重视从肝论治,疏肝理气应贯穿整个治疗过程。临证注重分期、分型治疗,以疏肝理气、化痰散结、活血化瘀为主要治疗原则。早期患者多表现为气郁痰阻型和胃热亢盛型,可分别予以四海舒郁丸合消瘰丸、白虎加人参汤合麦门冬汤加减治疗;中期以痰瘀互结型为主,可采用消瘰丸合桂枝茯苓丸加减治疗;后期多表现为气阴两虚型,可采用生脉散合麦门冬汤加减治疗。同时结合现代药理研究成果,酌情选用特色中药,如收敛固涩之龙骨、牡蛎,软坚散结之浙贝母、玄参、夏枯草、猫爪草、八月札,活血消癥之三棱、莪术,广东道地药材王不留行、岗梅根、荔枝核等。其辨治用药可为临床运用中药治疗结节性甲状腺肿提供借鉴。

醒消丸对结节性甲状腺肿模型大鼠甲状腺细胞增殖和凋亡的影响

目的:研究醒消丸对结节性甲状腺肿模型大鼠甲状腺细胞增殖和凋亡的影响。方法:采用丙基硫氧嘧啶(PTU)灌胃复制结节性甲状腺肿大鼠模型。造模成功后随机分为模型组,左甲状腺素钠片组(15.0μg/kg),醒消丸高、中、低剂量组(1.2 g/kg、0.6 g/kg、0.3 g/kg),另设对照组。给予相应药物干预6周后。检测甲状腺质量、相对质量;HE染色分析甲状腺组织的病理学变化;ELISA法检测血清中促甲状腺激素(TSH)、游离三碘甲腺原氨酶(FT3)、游离甲状腺素(FT4)水平;TUNEL染色分析甲状腺细胞的凋亡情况;Western blotting法检测增殖相关蛋白VEGF的表达水平。结果:左甲状腺素钠片组大鼠与醒消丸高、中、低剂量组大鼠甲状腺组织滤泡肿胀和增生减少,上皮细胞排列趋于规则,甲状腺上皮细胞肿胀和间质间炎症细胞浸润情况明显改善;与模型组比较,左甲状腺素钠片组、醒消丸高剂量和醒消丸低剂量组大鼠甲状腺相对质量降低(P<0.01),左甲状腺素钠片组和醒消丸高剂量组大鼠甲状腺质量显著降低(P<0.01);与模型组比较,左甲状腺素钠片组、醒消丸高剂量组和醒消丸中剂量组大鼠血清TSH水平降低(P<0.05或P<0.01),FT3水平明显升高(P<0.05),左甲状腺素钠片组及醒消丸高、中、低剂量组FT4水平明显升高(P<0.05或P<0.01);与模型组比较,醒消丸高、中剂量组大鼠甲状腺组织细胞凋亡显著升高(P<0.05);与模型组比较,左甲状腺素钠片组和醒消丸高、中剂量组大鼠甲状腺组织中VEGF蛋白相对表达量降低(P<0.01或P<0.05)。结论:醒消丸可降低结节性甲状腺肿大鼠血清中TSH的含量,升高FT3及FT4的含量,减轻结节性甲状腺肿大鼠的甲状腺组织结构改变,抑制甲状腺细胞增殖,促进甲状腺细胞凋亡。

血小板参数用于甲状腺良恶性结节鉴别诊断的价值研究

目的:探讨血小板参数在甲状腺良恶性结节鉴别诊断中的应用价值。方法:选取2020年1月—2021年12月青岛市黄岛区区立医院收治具备手术指征的46例甲状腺结节患者作为研究对象,回顾性分析患者的临床病理资料,收集患者血小板计数(PLT)、血小板分布宽度(PDW)、大血小板比率(P-LCR)、淋巴细胞计数,并计算血小板/淋巴细胞比值(PLR),评估血小板相关参数在甲状腺良恶性结节鉴别诊断中的应用价值。绘制PLR的ROC曲线并计算曲线下面积,根据约登指数计算出最合理的临界值和对应的敏感度、特异度。结果:甲状腺癌(观察组)患者PLT和P-LCR较结节性甲状腺肿(对照组)高,差异有统计学意义(F=1.747、0.742,P<0.05),观察组患者PDW较对照组高,差异无统计学意义(F=1.508,P>0.05)。观察组患者PLR高于对照组,差异有统计学意义(F=5.060,P<0.05)。PLR的ROC曲线下面积为0.713,敏感度为0.696,特异度为0.609,cut-off值为124.5。结论:术前外周血PLT、P-LCR、PLR对于甲状腺癌和结节性甲状腺肿的鉴别诊断具有一定的指导意义。

腔镜下甲状腺全切与甲状腺次全切除术治疗双侧结节性甲状腺肿临床效果比较研究

目的探讨腔镜甲状腺全切除术和次全切除术治疗双侧结节性甲状腺肿的效果。方法前瞻性研究选取广东省东莞市清溪医院普通外科2018年1月至2023年6月收治的60例双侧结节性甲状腺肿患者,按照治疗方式的不同分为对照组和观察组,每组各30例。观察组采用腔镜甲状腺全切除术治疗,对照组采用腔镜次全切除术治疗。比较两组手术指标、手术前后的甲状腺功能指标及炎症因子、并发症发生率及复发率。结果观察组各项手术指标均优于对照组(P<0.05)。手术后观察组甲状腺功能指标优于对照组(P<0.05)。手术后观察组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)均低于对照组(P<0.05)。观察组术后并发症总发生率及复发率均低于对照组(P<0.05)。结论双侧结节性甲状腺肿患者应用腔镜甲状腺全切除术的效果确切,可加快患者恢复,改善甲状腺功能,减轻机体炎症反应,降低并发症发生率和复发率。

结肠镜辅助冷圈套切术与高频电凝电切术治疗结-直肠小息肉患者的效果

目的:分析对比结肠镜辅助冷圈套切术与高频电凝电切术治疗结-直肠小息肉患者的效果。方法:选取2019年1月—2023年1月兴仁市人民医院收治的70例结-直肠小息肉患者作为研究对象,按随机数表法分为两组,各35例。对照组行结肠镜辅助高频电凝电切术,观察组行结肠镜辅助冷圈套切术。比较两组手术情况、应激反应、疼痛因子水平及并发症发生情况。结果:两组息肉切除数比较,差异无统计学意义(P>0.05);观察组息肉切除时间短于对照组,息肉完整切除率高于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。术前,两组去甲肾上腺素(NE)、皮质醇(Cor)、肾上腺素(E)、前列腺素E_(2)(PGE_(2))、P物质(SP)比较,差异无统计学意义(P>0.05);术后,观察组NE、Cor、E、PGE_(2)、SP低于对照组,差异有统计学意义(P<0.05)。结论:结肠镜辅助冷圈套切术治疗结-直肠小息肉患者效果更为显著,能够缩短息肉切除时间,提升息肉切除完整率,引起的应激反应、疼痛更轻,且并发症更少。

CT鉴别诊断甲状腺乳头状癌与结节性甲状腺肿的临床价值分析

目的:分析CT鉴别诊断甲状腺乳头状癌与结节性甲状腺肿的临床价值。方法:回顾性分析2019年1月—2022年12月临沂市沂水县人民医院收治的76例甲状腺结节高危风险患者的临床资料,病理结果显示,甲状腺乳头癌34例,结节性甲状腺肿42例。两组患者均接受CT检查,统计CT检查在甲状腺乳头状癌与结节性甲状腺肿中的诊断效能,分析两种疾病的CT影像学表现,明确CT检查在两种疾病中的鉴别诊断价值。结果:CT检查诊断甲状腺乳头状癌与结节性甲状腺肿的灵敏度为95.24%,特异度为97.06%,准确度为96.05%;甲状腺乳头癌结节体积、腺体峡部厚度大于结节性甲状腺肿,左叶腺体体积、右叶腺体体积小于结节性甲状腺肿,差异有统计学意义(P<0.001);甲状腺乳头癌单发结节、结节规则、甲状腺侵及被膜、钙化、晕圈占比高于结节性甲状腺肿,边界清晰、分界清楚、内部均匀占比低于结节性甲状腺肿,差异有统计学意义(P<0.05)。结论:CT鉴别诊断甲状腺乳头状癌与结节性甲状腺肿的临床价值较高,可为临床两种疾病的早期诊疗提供依据。