超声在激光消融甲状腺乳头状癌颈部转移性淋巴结中的应用价值(附3例报告)

Value of ultrasound in percutaneous laser ablation of cervical metastatic lymph nodes in papillary thyroid carcinoma: report of 3 cases

目的:探讨超声在经皮激光消融(percutaneous laser ablation,PLA)治疗甲状腺乳头状癌颈部转移性淋巴结中的应用价值。方法:对3例甲状腺乳头状癌颈部转移性淋巴结患者行超声引导下PLA治疗,术后采用彩色多普勒超声观察淋巴结血供,术后即刻和3 d采用超声造影观察消融灶范围,并观察有无并发症发生。术后30 d对淋巴结进行超声随访及血清甲状腺球蛋白水平测定。结果:3例患者均采用局部麻醉成功进行了PLA治疗,未发生明显并发症。术后彩色多普勒超声观察发现消融区无彩色血流信号,术后即刻和术后3 d超声造影显示消融范围内无明显造影剂灌注,术后30 d超声随访发现淋巴结有不同程度的缩小,而患者的血清甲状腺球蛋白水平在治疗前后保持稳定,未升高。结论:超声在PLA治疗甲状腺乳头状癌颈部转移性淋巴结中具有一定的应用价值。

Objective To evaluate the value of ultrasound in percutaneous laser ablation （PLA） of cervical metastatic lymph nodes in papillary thyroid carcinoma. Methods Three patients with single metastatic lymph node which was diagnosed by fine-needle aspiration cytology underwent ultrasound-guided PLA as a local treatment. After PLA, blood flow signals of lymph nodes were evaluated with color Doppler uhrasonography, and the extent of ablation was assessed by contrast-enhanced ultrasonography （CEUS） immediately and 3 days after PLA. Complications were recorded. All the patients were followed up at 30 days after PLA with conventional ultrasonography and measuring of serum level of thyroglobulin （Tg）. Results All 3 patients had the treatment completed successfully under local anesthesia. The procedure was well tolerated without serious complications, and the patients required no analgesics. Color Doppler ultrasonography demonstrated absence of vascular signals in the treated area, and CEUS showed no blood supply in the lesion area immediately and 3 days after PLA. Conventional ultrasonography at 30 days after PLA showed the treatment induced varying degrees of shrinkage of metastatic lymph nodes. Serum Tg levels maintained at a relatively low level before and 30 days after treatment. Conclusions Ultrasound is an useful tool for ablation of cervical metastatic lymph nodes by PLA in patients with papillary thyroid carcinoma.