Lewis B D, Hay I D, Charboneau J W, McIver B, Reading C C, Goellner J R
Department of Radiology, Mayo Clinic and Mayo Foundation, 200 First St., SW, Rochester, MN 55905, USA.
AJR Am J Roentgenol. 2002 Mar;178(3):699-704. doi: 10.2214/ajr.178.3.1780699.
The objective of this study was to evaluate the technique, efficacy, and side effects of percutaneous ethanol injection in patients with limited cervical nodal metastases from papillary thyroid carcinoma.
Fourteen patients who had undergone thyroidectomy for papillary thyroid carcinoma presented with limited nodal metastases (one to five involved nodes) in the neck between May 1993 and April 2000. All patients had received previous iodine-131 ablative therapy with a mean total dose per patient of 7,548 MBq. Ten of the patients either were considered poor surgical candidates or preferred not to have surgery, and all were unresponsive to iodine-131 therapy. Each metastatic lymph node was treated with percutaneous ethanol injection, and patients received both clinical and sonographic follow-up.
Twenty-nine metastatic lymph nodes in our 14 patients were injected. Mean sonographic follow-up was 18 months (range, from 2 months to 6 years 5 months). All treated lymph nodes decreased in volume from a mean of 492 mm(3) before percutaneous ethanol injection to a mean volume of 76 mm(3) at 1 year and 20 mm(3) at 2 years after treatment. Six nodes were re-treated 2-12 months after initial percutaneous ethanol injection because of persistent flow on color Doppler sonography (n = 4), stable size (n = 1), or increased size (n = 1). Two patients developed four new metastatic nodes during the follow-up period that were amenable to percutaneous ethanol injection. Two patients developed innumerable metastatic nodes that precluded retreatment with percutaneous ethanol injection. No major complications occurred. All patients experienced long-term local control of metastatic lymph nodes treated by percutaneous ethanol injection. In 12 of 14 patients, percutaneous ethanol injection was successful in controlling all known metastatic adenopathy.
Sonographically guided percutaneous ethanol injection is a valuable treatment option for patients with limited cervical nodal metastases from papillary thyroid cancer who are not amenable to further surgical or radioiodine therapy.
本研究的目的是评估经皮乙醇注射治疗甲状腺乳头状癌颈部局限性淋巴结转移患者的技术、疗效及副作用。
1993年5月至2000年4月期间，14例因甲状腺乳头状癌行甲状腺切除术的患者出现颈部局限性淋巴结转移（1至5个受累淋巴结）。所有患者均接受过碘-131消融治疗，每位患者的平均总剂量为7548MBq。其中10例患者被认为手术风险较高或不愿接受手术，且对碘-131治疗均无反应。对每个转移性淋巴结进行经皮乙醇注射治疗，并对患者进行临床及超声随访。
我们对14例患者的29个转移性淋巴结进行了注射。超声平均随访时间为18个月（范围为2个月至6年5个月）。所有接受治疗的淋巴结体积均减小，经皮乙醇注射前平均体积为492mm³，治疗后1年平均体积为76mm³，2年时平均体积为20mm³。6个淋巴结在首次经皮乙醇注射后2至12个月因彩色多普勒超声显示血流持续存在（4例）、大小稳定（1例）或增大（1例）而再次接受治疗。2例患者在随访期间出现4个新的转移性淋巴结，适合经皮乙醇注射治疗。2例患者出现无数转移性淋巴结，无法再次接受经皮乙醇注射治疗。未发生严重并发症。所有患者经皮乙醇注射治疗的转移性淋巴结均获得长期局部控制。14例患者中有12例，经皮乙醇注射成功控制了所有已知的转移性腺病。
对于不适合进一步手术或放射性碘治疗的甲状腺乳头状癌颈部局限性淋巴结转移患者，超声引导下经皮乙醇注射是一种有价值的治疗选择。
