ObjectiveTo investigate the predictive value of recurrent laryngeal nerve lymph nodes (RLN) status for supraclavicular lymph node (SLN) metastasis in esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical data of 83 patients with esophageal squamous cell carcinoma who underwent McKeown three-field lymphadenectomy from January 2017 to April 2018 in our hospital, including 53 males and 30 females with an average age of 64.07±7.05 years.ResultsThe SLN metastasis rate of the patients was 24.1%. The rate in the thoracic and abdominal metastases positive (N1-3) group and negative (N0) group was 37.8% and 13.0%, respectively, with a statistical difference (P<0.05). The rate of SLN metastasis was significantly different between the RLN metastasis positive (RLN+) and negative (RLN–) groups (39.1% vs. 18.3%, P<0.05). One side of RLN metastasis could lead to SLN metastasis on the opposite side. No correlation between the SLN metastasis and age, gender, location, differentiation degree, maximum tumor diameter, T-staging or histologic type was observed (P>0.05). Multivariate analysis showed that lymph node metastasis in chest or abdomen was an independent predictor of SLN metastasis.ConclusionRLN+ is not the independent predictor for SLN metastasis. SLN should be dissected in N1-3 patients with esophageal squamous cell carcinoma without considering tumor location and T-staging. Bilateral SLN dissection should be recommended even if RLN metastasis is only unilateral.
ObjectiveTo explore the related factors and nursing countermeasures for psychonosema in postoperative laryngeal cancer patients. MethodsWe retrospectively analyzed the clinical data of eight patients who accepted laryngectomy and developed psychonosema from January 2008 to April 2013. The related factors for psychonosema in these patients were analyzed and nursing countermeasures were summarized. ResultsEight patients had different degree of psychonosema, and it was correlated with psychological factors, various channels of undesirable stimulation, sleep disorders, drug and other factors. After treatment and careful nursing, within three to seven days, all patients' abnormal mental symptoms were alleviated, and all of them were discharged. ConclusionThere are many factors which can cause psychonosema after laryngectomy for laryngeal carcinoma. Medical staff should try to reduce or avoid inducing factors. Once it happens, medical staff should carry out psychiatric treatment in time to avoid accidents and promote the rehabilitation of patients.
ObjectiveTo evaluate the safety and necessity of recurrent laryngeal lymph node resection by comparing the complications and prognosis of patients with recurrent laryngeal nerve injury receiving different recurrent laryngeal lymph node resections.MethodsWe reviewed the clinical data of 153 patients with stage T1N0M0 esophageal squamous cell carcinoma who underwent radical esophageal cancer surgery at the Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2014 to May 2016. Among them, 125 were male and 28 were female, at an average age of 62 years. All patients underwent bilateral recurrent laryngeal nodes sampling. They were divided into 3 groups according to the dissection situation: patients with only one recurrent laryngeal lymph node resection on both sides during the operation were treated as a sampling group (n=49); patients with only one recurrent laryngeal lymph node resection on one side and more than one recurrent laryngeal lymph nodes resection on the other side were treated as a unilateral dissection group (n=49); patients with more than one recurrent laryngeal lymph nodes resection on both sides were treated as a bilateral dissection group (n=55). Follow-up was performed to compare the prognostic differences among the three groups. Seven days after the operation, the vocal cords of the patients were examined with an electronic laryngoscope and classified using the Clavien-Dindo system. The differences in complications related to recurrent laryngeal nerve injury among the three groups were compared.ResultsThe 5-year overall survival (OS) rate of the patients in the sampling group, unilateral dissection group and bilateral dissection group was 66.8%, 88.5%, 93.8%, respectively. There was statistical difference between the sampling group and the unilateral dissection group or the bilateral dissection group (P<0.05), and no statistical difference between the unilateral dissection group and the bilateral dissection group (P>0.05). The incidence of complications among the three groups was not statistically different (P>0.05).ConclusionFor patients with esophageal squamous cell carcinoma of stage T1N0M0, the lymph nodes of the bilateral recurrent laryngeal nerves should be removed during the operation as many as possible, which will help improve the 5-year survival rate of the patients.
目的:總結喉返神經修復重建術圍手術期的護理配合。方法：我科2007年10～11月手術治療雙側喉返神經麻痹患者3例，手術前加強患者的心理護理、密切觀察病情變化，及時處理聲帶麻痹引起的喉梗阻、誤吸、嗆咳等癥狀。術后重視體位護理、呼吸道的管理、保證藥物及時準確使用，協助患者進行正確的吞咽進食訓練、聲帶協調運動訓練等康復護理。結果：3例患者術后均獲完整隨訪，3月后均順利拔除氣管套管，無吸氣性呼吸困難，無發音困難，嗓音質量較術前明顯改善。結論：良好的圍手術期護理有助于手術的成功。
目的:觀察經喉罩全憑七氟醚吸入麻醉在小兒腹股溝疝手術中的臨床應用效果。方法：60例ASAⅠⅡ級擇期行腹股溝疝囊高位結扎術的患兒隨機分成喉罩七氟醚組（實驗組）和氯胺酮組（對照組）。實驗組以七氟醚誘導后置入喉罩，經喉罩全憑七氟醚吸入維持麻醉，對照組以氯胺酮和異丙酚誘導和維持麻醉。比較兩組血流動力學、呼氣末CO2分壓（PETCO2）、手術時間、蘇醒時間、出室時間（在恢復室內停留時間）。記錄術中和術后不良反應如體動反應、嗜睡、惡心嘔吐等發生情況。結果：對照組在T3、T4、T5時點HR、BP均明顯高于實驗組相應時點（Plt;0.05）。實驗組患兒蘇醒時間和出室時間均明顯低于對照組（Plt;0.05）。對照組體動反應和嗜睡發生率明顯高于實驗組（Plt;0.05）。實驗組術后惡心發生率明顯高于對照組（Plt;0.05）。結論：經喉罩全憑七氟醚吸入麻醉用于小兒腹股溝疝手術，術中經過更平穩，麻醉恢復更快，術中及術后不良反應少。