Division of Head and Neck and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California 94115, USA.
Laryngoscope. 2011 Aug;121(8):1651-5. doi: 10.1002/lary.21774. Epub 2011 Jun 9.
To describe our technique and initial experience of intraoperative tumor localization with surgeon-performed ultrasound-guided needle dye injection.
Prospective case series. Technique description.
Using surgeon-performed ultrasonography (SP-US), 20 tumors (lymph node metastases of papillary thyroid carcinoma [15], Hurthle cell carcinoma [2], medullary thyroid carcinoma [1], and lymphoma [1], and a parathyroid adenoma [1]) were localized in 13 patients. With ultrasound guidance, 0.1 mL of 1% methylene blue dye was injected into each targeted tumor. The blue color in contrast helped guide the dissection. Sixteen of 20 (80%) of dissections were revision cases through scar.
Using SP-US and US-guided injection with blue dye, 20 of 20 (100%) of cases were successful in retrieving the target tumor with no inadvertent nerve injuries (nerves at risk in scar: recurrent laryngeal [12], phrenic [3], vagus [3], and sympathetic chain [3]). Dye injection adds 5 to 10 minutes of time prior to incision. Injections appeared to increase visual differentiation of tissue, save time during dissection, particularly during revision dissections, and help ensure successful target retrieval. Injection into a parathyroid adenoma resulted in an overabundance of blue dye in nontumor tissue.
Surgeon-performed ultrasound guided needle dye injection is particularly helpful in directing the surgeon to the appropriate area for tumor resection in fibrotic areas and thereby possibly reducing surgical time, sampling error, and morbidity. A lower concentration or a different dye may be more helpful for parathyroid adenomas. Further study on this technique is needed and is under way with a larger group of patients.
At the conclusion of this manuscript, the participants should be able to understand the technique and advantages of intraoperative tumor localization with surgeon-performed ultrasound-guided needle blue dye injection.
描述我们术中应用超声引导下术者注射染料进行肿瘤定位的技术和初步经验。
前瞻性病例系列。技术描述。
使用术者超声（SP-US），在 13 名患者中定位了 20 个肿瘤（甲状腺乳头状癌淋巴结转移[15]、Hurthle 细胞癌[2]、甲状腺髓样癌[1]和淋巴瘤[1]、甲状旁腺腺瘤[1]）。在超声引导下，向每个靶向肿瘤注射 0.1ml 浓度为 1%的亚甲蓝染料。蓝色染料的颜色有助于引导解剖。20 例（80%）中的 16 例为通过瘢痕进行的再次手术。
使用 SP-US 和超声引导下注射蓝色染料，20 例（100%）均成功地切除了目标肿瘤，没有造成神经损伤（在瘢痕中存在风险的神经：喉返神经[12]、膈神经[3]、迷走神经[3]和交感神经链[3]）。染料注射在切口前增加了 5-10 分钟的时间。注射似乎增加了组织的视觉差异，缩短了解剖时间，尤其是在再次手术中，有助于确保目标物的成功切除。注射到甲状旁腺腺瘤中导致非肿瘤组织中出现过多的蓝色染料。
术者超声引导下的针染料注射特别有助于指导术者切除纤维化区域的肿瘤，从而可能减少手术时间、采样误差和发病率。较低的浓度或不同的染料可能对甲状旁腺腺瘤更有帮助。这项技术需要进一步研究，目前正在对更大的患者群体进行研究。
在本文结束时，参与者应该能够理解术中应用超声引导下术者注射染料进行肿瘤定位的技术和优势。
