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经皮激光消融对甲状腺乳头状癌术后颈部转移性淋巴结的疗效:前瞻性队列研究

张璐 周伟 彭艳 詹维伟

张璐, 周伟, 彭艳, 詹维伟. 经皮激光消融对甲状腺乳头状癌术后颈部转移性淋巴结的疗效:前瞻性队列研究[J]. 协和医学杂志, 2021, 12(1): 67-72. doi: 10.12290/xhyxzz.20190238
引用本文: 张璐, 周伟, 彭艳, 詹维伟. 经皮激光消融对甲状腺乳头状癌术后颈部转移性淋巴结的疗效:前瞻性队列研究[J]. 协和医学杂志, 2021, 12(1): 67-72. doi: 10.12290/xhyxzz.20190238
ZHANG Lu, ZHOU Wei, PENG Yan, ZHAN Wei-wei. Efficacy of Percutaneous Laser Ablation in the Treatment of Cervical Metastatic Lymph Nodes after the Surgery of Papillary Thyroid Carcinoma: A Prospective Cohort Study[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(1): 67-72. doi: 10.12290/xhyxzz.20190238
Citation: ZHANG Lu, ZHOU Wei, PENG Yan, ZHAN Wei-wei. Efficacy of Percutaneous Laser Ablation in the Treatment of Cervical Metastatic Lymph Nodes after the Surgery of Papillary Thyroid Carcinoma: A Prospective Cohort Study[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(1): 67-72. doi: 10.12290/xhyxzz.20190238

经皮激光消融对甲状腺乳头状癌术后颈部转移性淋巴结的疗效:前瞻性队列研究

doi: 10.12290/xhyxzz.20190238
基金项目: 

上海申康医院发展中心临床辅助科室(超声医学)能力建设项目 SHDC22015006

详细信息
    通讯作者:

    詹维伟  电话:021-64370045-362563,E-mail:shanghairuijin@126.com

  • 中图分类号: R739.91

Efficacy of Percutaneous Laser Ablation in the Treatment of Cervical Metastatic Lymph Nodes after the Surgery of Papillary Thyroid Carcinoma: A Prospective Cohort Study

Funds: 

Capacity Building Project of Clinical Auxiliary Department of Shanghai Shenkang Hospital Development Center (Ultrasonic Medicine) SHDC22015006

More Information
  • 摘要:   目的  观察超声引导下经皮激光消融(percutaneous laser ablation, PLA)治疗甲状腺乳头状癌(papillary thyroid carcinoma,PTC)术后颈部转移性淋巴结(metastatic lymph nodes,MLNs)的疗效。  方法  前瞻性收集并分析2014年1月至2016年9月因PTC术后复发于上海交通大学医学院附属瑞金医院接受PLA治疗患者的临床资料。PLA术中均应用二维超声监测手术过程,评估消融后病灶变化及并发症发生情况。PLA术前及术后1 h、2~7 d内分别行超声造影检查,评估MLNs病灶灌注缺损情况。对所有患者随访(截至2019年5月),记录随访中消融后病灶最大径和体积。  结果  共35例(46个MLNs病灶)符合纳入和排除标准的患者入选本研究。术前超声造影显示,20个MLNs为不均匀灌注(包括1个液化淋巴结),26个为均匀灌注。术后2~7 d复查超声造影显示,灌注缺损区边界较术后1 h更清晰,灌注缺损区体积比术后1 h明显增大[230.40(78.03,361.17)mm3比130.62(43.06,253.66)mm3P<0.05]。所有患者对PLA均耐受良好,无颈部血肿及活动性出血、感染、气管食管损伤等并发症发生。平均随访(56.7±8.9)个月,无原位淋巴结复发病例。与术前比较,末次随访时消融后病灶最大径[0.00(0.00,0.00)mm比7.35(5.70,9.63)mm,P<0.05]、病灶体积[0.00(0.00,0.00)mm3比95.59(32.82, 169.01)mm3P<0.05]均显著缩小。术后1、3个月及末次随访时消融后病灶体积缩小率分别为100(40.381,100)%、100(96.110,100)%和100(100,100)%。  结论  超声引导下PLA对PTC术后颈部MLNs具有一定的治疗作用。
    作者贡献:张璐负责超声操作、资料收集、病例随访、数据整理分析、文章撰写; 周伟负责手术操作、病例随访; 彭艳负责资料收集、数据整理; 詹维伟负责超声操作、统筹安排。
    利益冲突  无
  • 图  1  一例右侧颈部Ⅵ区转移性淋巴结患者经皮激光消融术后的超声造影图像

    A.术后1 h灌注缺损体积较小(圆圈); B.术后第7天灌注缺损体积明显增大(圆圈)

    图  2  一例左侧颈部Ⅳ区液化转移性淋巴结患者经皮激光消融治疗前后的二维超声及超声造影图

    A.消融前超声造影示淋巴结中心为灌注缺损区(箭头),提示中央有液化坏死; B.超声引导下细针抽吸囊液后再行消融(箭头); C.消融后1 h二维超声示淋巴结内部有团状强回声气化区,后方有声衰减(箭头); D.消融后1 h超声造影示消融灶内部无造影剂灌注(箭头)

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  • 收稿日期:  2019-10-30
  • 录用日期:  2020-04-24
  • 刊出日期:  2021-01-30

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