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

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

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

摘要

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)mm³，P＜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)mm³，P＜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。

Abstract:
Objective The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided percutaneous laser ablation (PLA) in the treatment of cervical metastatic lymph nodes (MLNs) after the surgery of papillary thyroid carcinoma (PTC).
Methods Clinical data of patients with recurrent PTC after surgery undergoing PLA treatment and regular follow-up from January 2014 to September 2016 were prospectively collected in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Two-dimensional ultrasound was used to monitor the intraoperative process of PLA, and to evaluate the complications and lesion changes after ablation. Contrast-enhanced ultrasound(CEUS) was performed before treatment and at 1 h and 2-7 d after PLA to evaluate perfusion defects. All patients were followed up(As of May 2019), and the maximum diameter and volume of lesions after ablation were recorded during follow-up.
Results A total of 35 patients (46 cervical MLNs) meeting the inclusive and exclusive criteria were enrolled in this study. Preoperative CEUS showed that 20 MLNs were heterogeneously perfused (including 1 liquefied lymph node), while 26 MLNs were homogeneously perfused. During 2-7 d after PLA, CEUS showed that the boundary of the perfusion-defect area was clearer than that of 1 h after the operation, and the volume of the perfusion-defect area was significantly larger than that of 1 h after the operation230.40(78.03, 361.17)mm³ vs. 130.62(43.06, 253.66)mm³, P < 0.05. All patients tolerated well to PLA without neck hematoma, active bleeding, infection, tracheal esophageal injury, or other complications. The mean follow-up was (56.7±8.9)months, and there was no case of lymph node recurrence in situ. The maximum diameter 0.00(0.00, 0.00)mm vs. 7.35(5.70, 9.63)mm, P < 0.05 and the lesion volume 0.00(0.00, 0.00)mm³ vs. 95.59(32.82, 169.01)mm³, P < 0.05 at the last follow-up after ablation were significantly reduced compared with preoperation.
Conclusions PLA guided by ultrasound guidance may have a certain therapeutic effect on the neck MLNs after PTC surgery.

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