thyroid nodules is mainly divided into benign nodules and malignant nodules. Malignant nodules account for 5%-15% of all thyroid nodules, and benign nodules account for about 85%. Although most thyroid nodules are benign, some malignant thyroid nodules require surgery.
What kind of situations do you need surgical treatment?
Most thyroid nodules are benign and can be done with long-term follow-up. only has the following cases that we need surgical treatment. First of all, the nodules are malignant. is clear whether it is clear through puncture or not clear through puncture, but imaging, such as B-ultrasound or CT, or repeated punctures are not clear, the patient is under great pressure. Some patients feel very worried about having a nodule and want to come to the hospital to draw blood tests for examinations. If this causes great mental stress to the patient, is also recommended for surgical treatment.
The lump is huge, generally the lump is larger than 4cm and the benign nodules are larger than 4cm. Surgical treatment should also be considered. Because the overall area of the neck is not very large, 4cm is obviously already prominent outside the body surface. Some lumps are just in front of the trachea, which can cause various discomforts such as compressing the trachea. Even if the lump is not too big, surgical treatment should be considered as long as the trachea is compressed.
Goiter behind the sternum. Some patients with hyperthyroidism have ineffective or intolerable repeated medications, and cannot undergo iodine 131 treatment, you can consider doing subtotal thyroidectomy. After , it is equivalent to curing hyperthyroidism, and there is no need to take medication for life.
high-function adenoma, can be completely cured as long as the tumor is cut off, and there is no need to take medicine.
What are the surgical methods for thyroid nodules?
thyroid nodules mainly include thyroid lobes, lateral lobe resection, thyroid isthectomy and total thyroid resection. If it is malignant, it may be determined based on the situation whether to perform lymph node dissection in the central area, or lymph node dissection in the lateral cervical area. The scope and method of the operation are mainly determined based on the location, size, benign and malignant, pathology, type, and lymph nodes of the tumor. Of course, it should also be based on the patient's age, overall condition, etc.
What are the postoperative complications of thyroid nodule surgery?
All surgeries have surgical risks. For most thyroid surgery, we take general anesthesia , which has the corresponding risk of general anesthesia, such as cardiovascular and cerebrovascular accidents. Fortunately, our hospital has conducted thyroidectomy under acupuncture since this year, and many cases have been carried out. The thyroidectomy under needle anesthesia completely avoids the risk of general anesthesia . During the operation, patients can drink water and speak, and people are completely awake. You can walk back to the ward immediately after the operation and eat immediately. Unlike general anesthesia, it may take 6 hours to eat, and there is no risk of general anesthesia.
Some surrounding tissues and organs next to the thyroid gland are damaged, such as recurrent laryngeal nerve damage , supra laryngeal nerve damage, parathyroid damage, tracheoesophageal damage, bleeding, etc.
Hoarseness may occur after surgery. Hoarseness is a more serious complication after thyroid surgery and is not common. It is mainly manifestation of recurrent laryngeal nerve damage. In addition, drinking water to cough is a sign of supra throat nerve damage. If parathyroid gland is damaged, it will cause numbness throughout the body, numbness in the hands and feet, and numbness in the mouth. In severe cases, cramps will occur and calcium supplements are needed to relieve it.
After the operation, the skin in the neck was numb, sensory disorders, swelling of the skin at the incision, and foreign body sensation in the pharynx . If it is thyroid cancer , dissection of the lymph nodes in the lateral cervical area may also damage the paraneal nerves, causing upper limb lifting and abduction, and forming a chylori.
How to alleviate these postoperative complications?
Fortunately, there are many technologies that can avoid some serious complications.The first is post-median monitoring of the recurrent laryngeal nerve, which mainly monitors the recurrent laryngeal nerve. During the operation, you can monitor the recurrent laryngeal nerve function throughout the operation to know whether there is any damage. Another one is nanocarbon parathyroid negative development technology, which can quickly distinguish whether it is a parathyroid gland or a lymph node, help us protect the parathyroid gland and reduce parathyroid damage.
Some minimally invasive surgeries . For example, some women love beauty and are unhappy on the neck and are unwilling to leave any scars on the neck . They can undergo laparoscopic surgery. This scar can be hidden around the areola or in the mouth. can make the entire neck without scars , which also reduces many people's concerns.
Thermal ablation surgery guided by ultrasound, but the ablation surgery is still very controversial now. Because the local area may not be completely clean when treated with ablation, some tumors are very large, and ablation may not be completely burned. The characteristics of papillary carcinoma are easy to cause lymph node metastasis. Sometimes metastasized lymph nodes cannot be treated if they are ablated. Therefore, we should adopt a more conservative attitude towards ablation. Mainly, for patients with some benign nodules, ablation surgery can be considered.
is also some new energy equipment, including bipolar electrocoagulation and ultrasonic knife. Because the neck anatomy is relatively fine, the recurrent laryngeal nerve is very fragile. Sometimes, even if it is physically complete, you have already dissected it. When you see that the nerve is one, it is placed in front of you without any damage. However, sometimes it is slightly burned by hot water or by an electric knife, and its functionality has been lost. It has no function and no nerve conduction function. Of course, this condition can be recovered for a certain period of time after the operation. Without physical dissection, it can be recovered by itself. But for smaller ones, such as ultrasonic knives, this heat conduction is very low and can better protect the integrity of the nerves.
Recurrent laryngeal nerve monitoring technology has two metal guidewires on each side. This guidewire is attached to the vocal cord on one side, and there are two other vocal cords on the other side, that is, the other side is attached to the other side. During the operation, the recurrent laryngeal nerve can be stimulated, and the recurrent laryngeal nerve can be probed with a probe. The recurrent laryngeal nerve can act on the vocal cords. It can be received through the receiver, and the movement of the recurrent laryngeal nerve can be displayed on the display. If you find that its waveform suddenly drops sharply, you have to doubt whether it is already close to the nerves, or whether the patient's nerves are already a little hot. This allows you to observe the nerves in real time. With recurrent laryngeal nerve monitoring technology, the incidence of recurrent laryngeal nerve injury will basically be very low.
nanocarbon parathyroid development technology mainly uses nanocarbon to prevent the parathyroid gland from developing and develop the surrounding lymph nodes. You can clearly distinguish which parathyroid glands are parathyroid glands and which lymph nodes are. You can cut off what should be cut and retain what should be retained.
Sha Yingying: Associate Chief Physician; Department of Thyroid Hernia Surgery at Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Youth Committee Member of Shanghai Society of Integrated Traditional Chinese and Western Medicine; Youth Committee Member of Shanghai Perioperative Professional Committee of Integrated Traditional Chinese and Western Medicine
Good at: Long-term basic and clinical work on the treatment of thyroid and abdominal wall hernia diseases, good at the surgery and comprehensive treatment of thyroid nodules, thyroid tumors and abdominal wall hernia, carry out new technologies such as ultrasound-guided puncture biopsy, liquid-based cytology examination, etc., so that the preoperative diagnosis rate of thyroid cancer reaches more than 98%, and is good at various open and minimally invasive thyroid surgeries, standardized lymph node dissection of thyroid cancer, minimally invasive surgery for abdominal wall hernia and comprehensive treatment of combined traditional Chinese and Western medicine.
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