McCoy Kelly L, Yim John H, Tublin Mitchell E, Burmeister Lynn A, Ogilvie Jennifer B, Carty Sally E
University of Pittsburgh, Department of Surgery, Pittsburgh, Pennsylvania, USA.
Surgery. 2007 Dec;142(6):965-72. doi: 10.1016/j.surg.2007.09.021.
Reoperation for locally recurrent papillary thyroid cancer (PTC) is technically difficult and associated with higher morbidity. This study evaluated the use of same-day ultrasound guidance (SDUS) as an adjunct.
We compared 2 cohorts of consecutive patients with a single impalpable focus of recurrent PTC. Group I (August 2001-January 2004) was explored based on results of imaging. Group II (April 2004-January 2007) had an additional SDUS, performed before incision with indelible skin marking directly over the lesion. Outcome measures included failure to resect, lesion size, and postoperative change in thyroglobulin.
In group I, in 3 of 6 cases the surgeon was unable to find the preoperatively imaged focus. By contrast, all 19 group II patients had successful resection of the lesion facilitated by SDUS (P < .01). SDUS resection was more likely to succeed even though group II lesions were smaller (mean 17 vs 11 mm; P = .009). Mean operative times did not differ but morbidity was lower (P < .01) in group II. Postresection serum thyroglobulin levels dropped to undetectable in 50% of evaluable cases.
When focused resection of recurrent PTC is considered appropriate, SDUS guidance is an efficient and useful adjunct, allowing resection of lesions as small as 6 mm.
局部复发性乳头状甲状腺癌（PTC）再次手术在技术上具有挑战性，且并发症发生率较高。本研究评估了同日超声引导（SDUS）作为辅助手段的应用。
我们比较了两组连续性复发性PTC且触诊不可及的单个病灶患者。第一组（2001年8月至2004年1月）根据影像学结果进行探查。第二组（2004年4月至2007年1月）在切开前额外进行了SDUS检查，并在病变上方的皮肤上用不可擦除的标记直接标记。观察指标包括切除失败、病灶大小以及术后甲状腺球蛋白的变化。
在第一组中，6例中有3例外科医生未能找到术前影像学显示的病灶。相比之下，第二组的所有19例患者在SDUS辅助下均成功切除了病灶（P <.01）。尽管第二组的病灶较小（平均17对11毫米；P =.009），但SDUS切除更有可能成功。平均手术时间无差异，但第二组的并发症发生率较低（P <.01）。在50%的可评估病例中，切除术后血清甲状腺球蛋白水平降至无法检测。
当认为对复发性PTC进行精准切除合适时，SDUS引导是一种有效且有用的辅助手段，能够切除小至6毫米的病灶。
