University of California, Los Angeles, Section of Endocrine Surgery, Los Angeles, CA 90095, USA.
J Am Coll Surg. 2012 Oct;215(4):555-61. doi: 10.1016/j.jamcollsurg.2012.06.006. Epub 2012 Jul 21.
Reoperation in the neck can be challenging and is associated with increased complication rates and operative times. Here we analyze our methylene blue dye injection method to localize reoperative neck pathology in patients with thyroid cancer and lymph node metastases.
We retrospectively reviewed the records of all patients at a single university tertiary care center who had reoperative neck surgery for recurrent thyroid cancer between 2004 and 2009, and who also underwent intraoperative methylene blue dye injection. Outcomes measured were efficacy and safety of the injection technique as well as complication rates.
Fifty-three operations were performed in 44 patients (average age, 51.2 years [range 16 to 83 years]). Ninety-one percent (48 of 53) of the operations resulted in successful resection of recurrent disease. Of these, 96% (46 of 48) were guided successfully by blue dye injection. Thyroglobulin became undetectable in 42% (11 of 26) of patients. Neck pathology included the following thyroid cancers: papillary (48 of 53), follicular (2 of 53), medullary (2 of 53), and tall cell variant (1 of 53). Among these patients, there were a total of 26 central and 38 lateral neck dissections. The average number of previous neck dissections was 2 (range 1 to 5). The mean intraoperative ultrasound/injection time was 21.3 min (n = 13). Median operative time was 90 minutes (range 40 to 300 minutes). Complications included 2 permanent vocal cord paralyses, 1 instance of permanent hypocalcemia, and 3 instances of temporary hypocalcemia. There were no complications related to the dye injection.
Intraoperative, ultrasound-guided, methylene blue dye injection is a safe and effective technique. It facilitates tumor localization and removal especially in patients requiring reoperative neck surgery.
颈部再次手术具有挑战性，并且与更高的并发症发生率和手术时间相关。在此，我们分析了我们的亚甲蓝染料注射方法，以定位甲状腺癌和淋巴结转移患者的复发性颈部病变。
我们回顾性分析了 2004 年至 2009 年期间在一家大学三级保健中心接受复发性颈部手术治疗复发性甲状腺癌且术中接受亚甲蓝染料注射的所有患者的记录。测量的结果是注射技术的有效性和安全性以及并发症发生率。
44 例患者中有 53 例（平均年龄 51.2 岁[16 至 83 岁]）进行了 53 次手术。91%（48/53）的手术成功切除了复发性疾病。其中，96%（46/48）通过蓝染成功引导。42%（11/26）的患者甲状腺球蛋白检测不到。颈部病变包括以下甲状腺癌：乳头状（48/53）、滤泡状（2/53）、髓样（2/53）和高细胞变异型（1/53）。在这些患者中，共有 26 例中央颈部清扫术和 38 例侧颈部清扫术。平均既往颈部清扫术次数为 2 次（范围 1 至 5 次）。术中超声/注射时间的平均值为 21.3 分钟（n=13）。中位手术时间为 90 分钟（范围 40 至 300 分钟）。并发症包括 2 例永久性声带麻痹、1 例永久性低钙血症和 3 例暂时性低钙血症。无与染料注射相关的并发症。
术中超声引导的亚甲蓝染料注射是一种安全有效的技术。它有助于肿瘤定位和切除，特别是对于需要再次进行颈部手术的患者。
