ObjectiveTo evaluate the safety, efficacy, and advantages of gasless trans-subclavian approach endoscopic parathyroidectomy (GTAEPT) in the treatment of primary hyperparathyroidism (PHPT). MethodsA retrospective analysis was conducted on the clinical data of 10 patients with PHPT who underwent GTAEPT at Xuzhou Central Hospital from October 2022 to September 2024. Data collected included operative time, recurrent laryngeal nerve exposure time, intraoperative blood loss, total drainage volume within the first two postoperative days, total hospital stay, changes in preoperative and postoperative intact parathyroid hormone (PTH) and serum calcium levels, and the occurrence of postoperative complications such as hoarseness, choking during drinking, active bleeding, and surgical site infection. Additionally, PTH and serum calcium levels were monitored at 6-month postoperatively. ResultsAll surgical procedures were successfully completed in the 10 patients. The operative time was (67.0±14.5) min, recurrent laryngeal nerve exposure time was (15.3±8.2) s, intraoperative blood loss was (9.5±3.5) mL, total drainage volume within the first two postoperative days was (36.7±5.2) mL, and total hospital stay was (6.4±1.0) d. The preoperative-to-postoperative differences in PTH and serum calcium levels [mean difference (95%CI)] were 191.3 (160.7, 220.0) ng/L and 0.5 (0.3, 0.6) mmol/L, respectively, both returning to normal reference ranges. Only one case of transient hoarseness was observed postoperatively, with no complications such as active bleeding, choking during drinking, or surgical site infection. At the 6-month follow-up, all patients maintained serum PTH and calcium levels within the normal reference ranges. ConclusionsGTAEPT has preliminarily demonstrated safety and feasibility in treating PHPT, with short intraoperative recurrent laryngeal nerve exposure time, rapid postoperative normalization of PTH and serum calcium levels, and stable therapeutic outcomes during the 6-month follow-up. This technique combines the benefits of minimal invasiveness and favorable cosmesis, representing a viable treatment option for patients with unilateral parathyroid lesions.
ObjectiveTo explore the therapeutic effect of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma. MethodsThe clinicopathologic data of patients with unilateral papillary thyroid microcarcinoma who were treated by gasless endoscopic thyroidectomy via axillary posterior approach (observation group) or breast approach (control group) in the Xuzhou Central Hospital from January 2020 to February 2022 were collected. The operation time, accidental intraoperative bleeding, exposure time of recurrent laryngeal nerve, number of lymph node dissection, total hospital stay, and postoperative complications such as superior laryngeal nerve injury, cough due to drinking, temporary hoarseness, transient hypocalcemia, tunnel hematoma, and neck discomfort were compared between the two groups. Meanwhile, the cosmetic effects of the two groups were evaluated. ResultsA total of 87 patients who met the study conditions were enrolled in this study, including 47 cases in the observation group and 40 cases in the control group. There were no statistical differences in the baseline data such as gende, age, maximum tumor diameter, location of tumor, etc. between the two groups (P>0.05). Compared with the control group, the exposure time of recurrent laryngeal nerve was shorter (P<0.001) and the number of lymph node dissection was more (P=0.034), but the accidental intraoperative bleeding during operation was more (P=0.015) in the observation group. There were no statistical differences in the operation time and total hospital stay between the two groups (P>0.05). There were no superior laryngeal nerve injury and cough due to drinking in the two groups after operation, and there were no statistical differences between the two groups in the terms of postoperative temporary hoarseness, transient hypocalcemia, and tunnel hematoma (P>0.05), but it was found that the incidence of postoperative neck discomfort in the observation group was lower than that in the control group (P=0.043), and the postoperative cosmetic satisfaction score was also higher than that in the control group (P<0.001). ConclusionsFrom the results of this study, gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma is safe and feasible. It can quickly expose the recurrent laryngeal nerve and greatly improve the efficiency of lymph node dissection, as well as the cosmetic effect is better.
Objective To establish and validate a risk prediction model for post-thrombotic syndrome (PTS) in patients after interventional treatment for acute lower extremity deep vein thrombosis (LEDVT). MethodsA retrospective study was conducted to collect data from 234 patients with acute LEDVT who underwent interventional treatment at Xuzhou Central Hospital from December 2017 to June 2022, serving as the modeling set. Factors influencing the occurrence of PTS were analyzed, and a nomogram was developed. An additional 98 patients from the same period treated at the Xuzhou Cancer Hospital were included as an external validation set to assess the reliability of the model. ResultsAmong the patients used to establish the model, the incidence of PTS was 25.2% (59/234), while in the validation set was 31.6% (31/98). Multivariate logistic regression analysis of the modeling set identified the following factors as influencing PTS: age (OR=1.076, P=0.001), BMI (OR=1.163, P=0.004), iliac vein stent placement (OR=0.165, P<0.001), history of varicose veins (OR=5.809, P<0.001), and preoperative D-dimer level (OR=1.341, P<0.001). These 5 factors were used to construct the risk prediction model. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was 0.869 [95%CI (0.819, 0.919)], with the highest Youden index of 0.568, corresponding to a sensitivity of 79.7% and specificity of 77.1%. When applied to the validation set, the AUC was 0.821 [95%CI (0.734, 0.909)], with sensitivity of 77.4%, specificity of 76.1%, and accuracy of 76.6%. ConclusionsThe risk prediction model for PTS established in this study demonstrates good predictive performance. The included parameters are simple and practical, providing a useful reference for clinicians in the preliminary screening of high-risk PTS patients.