甲状腺术中喉返神经显露对暂时性喉返神经损伤发生率的影响

目的:探究甲状腺术中喉返神经显露对暂时性喉返神经损伤发生率的影响。方法:选择我院2016年10月-2018年10月收治的行甲状腺切除术的115例患者为研究对象,按照其入院顺序经随机数字表法分为两组,两组患者均行常规甲状腺切除术。其中,对照组58例患者未显露喉返神经;研究组57例患者常规显露喉返神经,记录并比较两组患者的手术时间、术中出血量、术后引流量、切口长度和住院时间等围术期手术指标,术后1d、4d、7d的甲状旁腺激素(PTH)水平、钙离子(Ca2+)水平,术后暂时性喉返神经损伤、术后声音嘶哑、低钙血症等并发症的发生情况。结果:研究组患者的手术时间、术中出血量、术后引流量均短于(少于)对照组(P0.05),但两组患者的切口长度和住院时间无显著性差异(P0.05);研究组患者术后1d、4d、7d的血清PTH、Ca2+水平均高于对照组(P0.05),暂时性喉返神经损伤、术后声音嘶哑、低钙血症发生率均低于对照组(P0.05)。结论:甲状腺术中喉返神经显露可有效预防暂时性喉返神经和甲状腺功能的损伤,降低术后并发症的发生率,且患者的围术期指标均显著改善。     

Thyroid Hormone Treatments Differentially Affect the Temperature Kinetics Properties of FoF1 ATPase and Succinate Oxidase as well as the Lipid/Phospholipid Profiles of Rat Kidney Mitochondria: A Correlative Study

Effect of thyroidectomy (Tx) and subsequent treatment with 3,5,3′-triiodo-l-thyronine (T₃) or replacement therapy (T_R) with T₃ + l-thyroxine (T₄) on the temperature kinetics properties of FoF₁ adenosine triphosphatase (ATPase, ATP synthase, H⁺-translocating ATP synthase EC 3.6.3.14) and succinate oxidase (SO) and on the lipid/phospholipid makeup of rat kidney mitochondria were examined. Tx lowered ATPase activity, which T₃ treatment restored. SO activity was unchanged in Tx but decreased further by T₃ treatment. T_R restored both activities. The energies of ATPase activation in the high and low temperature ranges (E _H and E _L) increased in the Tx and T₃ animals with decrease in phase transition temperature (Tt). T_R restored E _H and E _L but not Tt to euthyroid levels. E _H and E _L of SO decreased in Tx animals. T₃ and T_R restored E _H whereas E _L was restored only in the T_R group; Tt increased in both groups. Total phospholipid and cholesterol contents decreased significantly in Tx and T₃-treated animals. In Tx animals, sphingomyelin (SPM) and phosphatidylcholine (PC) components decreased, while phosphatidylserine (PS) and diphosphatidylglycerol components increased. T₃ and T_R treatments caused decreases in SPM, phosphatidylinositol and PS. PC and phosphatidylethanolamine (PE) increased in the T₃ group. T_R resulted in increased lysophospolipids and PE. Changes in kinetic parameters of the two enzymes were differently correlated with specific phospholipid components. Both T₃ and T_R regimens were unable to restore normal membrane structure-function relationships.     

„Cellules de thyroïdectomie“ et „cellules de castration“ chez la Caille japonaise,Coturnix coturnix japonica

Résumé On compare l'ultrastructure et la localisation des phosphatases acides au niveau des cellules hypophysaires delta et beta, chez des Cailles mâles thyroïdectomisées et maintenues en photopériode courte ou bien castrées, puis placées en photopériode longue. On étudie en outre, dans ces deux cas, les effets d'injections de doses croissantes de thyroxine.La thyroïdectomie provoque la transformation des cellules delta en cellules de thyroïdectomie groupées en îlots à la périphérie du lobe céphalique. Ces cellules sont pauvres en phosphatases acides. La thyroxine (10 g/j pendant 2 jours) provoque la régression de ces cellules et l'apparition de lysosomes. Les cellules beta ne sont pas modifiées par la thyroïdectomie.La castration-photostimulation stimule les cellules beta localisées dans le lobe céphalique. Elle provoque dans les deux lobes de la glande l'hypertrophie et la vacuolisation des cellules delta qui se distinguent des cellules de thyroïdectomie par la présence de nombreux lysosomes. La thyroxine freine simultanément l'activation des cellules delta et des cellules beta, en provoquant la formation de lysosomes, mais la dose efficace chez le mâle photostimulé (20 g et 60 g/j pendant 5 jours) est sans effet chez le castrat photostimulé (dose efficace 180 g/j).Pour interpréter ces faits, on admet que les cellules delta, thyréotropes et les cellules beta, gonadotropes, seraient simultanément soumises à un contrôle freinateur des hormones thyroïdiennes et des stéroïdes mâles.

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Thyroidectomy cells and castration cells in the Japanese quail, Coturnix coturnix japonica Ultrastructure and cytoenzymology

Summary The ultrastructure and the localization of acid-phosphatase activity are compared in beta and delta pituitary cells of male Japanese quail, either thyroidectomized and maintained in short days, or castrated then put in long days. Moreover, in these two cases, the effects of brief treatments with increasing doses of thyroxine are studied.Thyroidectomy induces transformation of delta cells into thyroidectomy cells arranged in clumps at the periphery of the cephalic lobe. The acid-phosphatase activity of such cells is low. Thyroxine (10 g per day for two days) causes regression of these cells and the appearance of numerous lysosomes. Beta cells are not modified by thyroidectomy.Castration and exposure to long days stimulate beta cells, localized in the cephalic lobe. It induces, also, in both pituitary lobes, hypertrophy and vacuolization of delta cells which differ from thyroidectomy cells by the presence of numerous lysosomes.Thyroxine in photostimulated quail inhibits both delta- and beta-cell stimulation and increases the frequency of lysosomes but the effective doses on males (20 g or 60 g per day for five days) are inactive on castrates, the response of which is obtained with 180 g per day.In order to explain these data, a hypothesis is suggested: Thyrotropic delta cells and gonadotropic beta cells are both subject to a double inhibiting control by thyroid hormones and male steroids.

Nous remercions très vivement pour leur excellente collaboration technique Mme Renée Picart (préparation des tissus pour la microscopie électronique) et M. Claude Pennarun (photographe).     

Secretory granules of prolactin cells of neonatally thyroidectomized female rats

In the anterior pituitary glands of neonatally thyroidectomized female rats sacrificed at 30 days of age, the prolactin granules were small and spherical in shape. The administration of thyroxine to neonatally thyroidectomized rats produced an obvious increase in the number and size of secretory granules in prolactin cells; comparatively large, pleomorphic secretory granules were frequently observed in these cells. These enlarged and pleomorphic granules closely resembled those observed in the prolactin cells of sham-operated control rats. These results may indicate that thyroxine stimulates the basic metabolism or cellular function of prolactin cells of neonatally thyroidectomized rats and leads to the formation of prolactin granules that are similar to those of sham-operated control rats.     

Changing ultrastructure of thyrotrophs in the rat anterior pituitary after thyroidectomy as studied by immuno-electron microscopy and enzyme cytochemistry

Summary The characteristic ultrastructure of thyrotrophs of the rat anterior pituitary was observed by immuno-electron microscopy and enzyme cytochemistry with increasing time after thyroidectomy (TX). The rough endoplasmic reticulum (ER) became dilated, the intracisternal granules reacted to serum raised against thyroid stimulating hormone (TSH) around 21 days after TX, and lysosomes and peculiar structures with positive acid phosphatase activity were present. The administration of thyroxine (T₄) to the thyroidectomized rats resulted in the reformation of secretory granules, a reduction of dilated cisternae of rough ER and the activation of the lysosomal systems. Morphological features indicating that the TX-cells might be derived from growth hormone (GH) cells or cells other than TSH cells, previously suggested by some researchers, were not recognized in the present study. The amount of serum and pituitary TSH was measured by radioimmunoassay (RIA), and correlated well with the morphological changes. These results indicate that the TX-cells are hypertrophied hyperfunctioning TSH cells that have been affected by the lack of negative feedback of thyroid hormone.     

Effect of thyroidectomy and subsequent treatment with triiodothyronine on kidney mitochondrial oxidative phosphorylation in the rat

The effect of thyroidectomy (Tx) and subsequent treatment with triiodothy-ronine (T₃) on rat kidney mitochondrial oxidative phosphorylation was examined. Thyroidectomy resulted in lowering of state 3 respiration rates and cytochrome contents. Thyroidectomized animals administered with T₃ (20 Μg/100 g body wt) resulted in the nonsynchronous stimulation of state 3 respiration rates in kidney mitochondria with glutamate, Β-hydroxybutyrate, succinate and ascorbate+TMPD as substrates. Cytoch-rome contents were also elevated differentially. Increase in the state 4 respiration rates was transient and reversible. However, primary dehydrogenases were not generally altered in the Tx and T₃-treated Tx animals. The results thus indicate that the T₃treatment to-Tx animals brings about differential and nonsynchronous increase in the respiratory parameters and respiratory chain components of kidney mitochondria.     

腔镜下甲状腺手术与传统开放性手术临床疗效对比

目的:比较腔镜下甲状腺手术与传统开放性甲状腺手术的临床治疗效果。方法:对2009年1月至2013年3月在我院行腔镜下甲状腺手术与传统开放手术治疗的200例患者进行分析比较,其中腔镜甲状腺手术组102例(腔镜组),传统开放手术组98例(传统组),比较两组的手术时间、术中出血量、术后引流量、拔管时间、住院时间、术后3及6个月美容效果评分(numerical score system,NSS)及并发症情况。结果:200例腔镜甲状腺手术成功完成,无中转开放手术;腔镜组平均手术时间、引流总量,拔管时间以及住院时间均明显高于传统组,差异具有统计学意义(P0.05);术中出血量则明显低于传统组(P0.05);术后腔镜组声音嘶哑、饮水呛咳及颈部感觉异常等并发症明显低于传统组(P0.05),而皮下积液和皮下气肿明显高于传统组(P0.05);腔镜组术后3个月及术后6个月NSS评分均明显高于传统组,差异有统计学意义(P0.05)。结论:腔镜下甲状腺手术临床疗效较传统开放性手术相比,具有手术出血较少,神经损伤率低以及美容效果优异等优势,但也存在一些并发症,需严格按照其适应证对患者进行选择,尊重患者自主选择权,增进医患和谐。     

不同手术方式对分化型甲状腺癌患者预后的影响

目的：探讨不同手术方式对分化型甲状腺癌患者临床治疗的效果及其预后的影响。方法：回顾性分析了2005.02-2012.07入住我院的60例分化型甲状腺癌患者的临床资料,采用如下三种不同的治疗方式：甲状腺切除术联合双侧中央区颈淋巴结清扫手术;保留对侧喉返神经入喉处甲状腺组织的甲状腺次全切除术联合单侧改良颈淋巴结清扫手术;保留对侧喉返神经入喉之处甲状腺组织的甲状腺次全切除手术联合双侧改良颈淋巴结清扫手术。结果：（1）上述三组患者术后,患者的甲状旁腺的功能低下之间均存在显著的统计学差异（P〈0.01）,三组喉返神经损伤的发生率之间也存在显著的统计学差异（P〈0.01）;本组60例患者均获10-172个月（平均为93.5±10.2）的随访,上述三种手术方式下患者的癌症复发率分别为77.8%、4.5%及45.0%,三组具有显著的统计学差异（P〈0.01）;生化治愈率分别为27.8%、95.5%及50.0%;平均生存时间分别为（92.3±12.5）个月、（105.8±14.5）个月及（112.3±20.9）个月。（2）三组患者术后生存质量总得分分别为（122±9）、（118±8）及（125±9）分。结论：与甲状腺切除术联合双侧中央区颈淋巴结清扫手术进行对比,保留对侧喉返神经入喉处甲状腺组织的甲状腺次全切除术联合单侧改良颈淋巴结清扫手术与保留对侧喉返神经入喉之处甲状腺组织的甲状腺次全切除手术联合双侧改良颈淋巴结清扫手术在生存时期、术后生存质量两个方面不具显著性差异。     

Thyroidectomy cells and their response to thyrotrophin releasing hormone (TRH) in the rat

Summary Thyroidectomy cells of the rat pituitary gland were studied by the peroxidase-antibody labeling procedure and by electron microscopy. Secretory granules accumulated in these cells in response to a short-term treatment with thyroxine, and the cells were then reactive to the peroxidase-antibody labeling procedure. An intravenous injection of synthetic thyrotrophin releasing hormone (TRH) to thyroxine-treated, thyroidectomized rats provoked an acute and active extrusion of secretory granules from the thyroidectomy cells. The secretory granules in these cells were mostly haloed after primary fixation in osmium tetroxide. It is concluded that TRH causes thyroidectomy cells to release their secretory granules, and presumably TSH, by the usual process of exocytosis or granule extrusion.This study was supported by USPHS Grant AM 12583.