甲状腺乳头状癌消融治疗后再手术策略

Policy of Re-operation for Papillary Thyroid Carcinoma after Radiofrequency Ablation Therapy

消融技术已被应用于甲状腺良性结节及不可手术的复发的甲状腺癌,包括韩国(KSThR,KSR)、意大利(SIUMB)的多数专家均反对消融技术用于初治可手术的甲状腺癌。但有一部分医生仍将该技术违规用于初治可手术患者,而且多个甲状腺治疗中心均报道了一批射频消融后残留再次手术的患者。在本文中,笔者对射频消融后的甲状腺癌病例手术策略进行探讨。鉴于射频消融后病灶的改变,建议可在平衡根治与术后生命质量、后期治疗的基础上部分参考局部晚期的甲状腺癌患者诊治策略,对于消融后局部受影响的气管、喉返神经、带状肌、胸锁乳突肌、颈内静脉、颈动脉等分别予以处置。且强调术前需获取肿瘤病理证据及进行详细的影像学评估,手术建议由经验丰富的甲状腺外科或头颈外科医生实施。

Radiofrequency ablation （RFA） can be used to treat both benign thyroid nodules and inoperable, recurrent thyroid cancers.Most medical specialists including KSThR（Korean Society of Thyroid Radiology）, KSR （Korean Society of Radiology）, SIUMB （Societa Italiana di Ultrasonologia in Medicina e Biologia）, do not recommend thyroid RF ablation for follicular neoplasms or primary thyroid cancers because there is no evidence of treatment benefit by RF ablation in follicular neoplasms or primary thyroid cancers.But several doctors have performed RF in primary thyroid cancers.Series of residual or recurrent cases after improper RF treated cases have been reported.The policy of these cases should be referred to local advanced thyroid cancer, which might involve cervical trachea, recurrent laryngeal nerve, cervical esophagus, internal jugular vein, sternocleidomastoid and strap muscles, and so on.Pathological proof, imagine of residual or recurrent focus should been obtained before operation, which should be performed by an experienced surgeon.