Eng Oliver S, Grant Scott B, Weissler Jason, Simon Mitchell, Roychowdhury Sudipta, Davidov Tomer, Trooskin Stanley Z
Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA.
Gland Surg. 2016 Dec;5(6):571-575. doi: 10.21037/gs.2016.12.12.
Surgical management of recurrent disease after total thyroidectomy and/or neck dissection for thyroid carcinoma remains a challenging clinical problem. Reoperation is associated with a significant increase in morbidity. Preoperative needle localization technique for non-palpable breast tumors has recently been extrapolated to head and neck surgery. We report on the use of preoperative ultrasound-guided needle localization for non-palpable recurrent operative bed disease as an intraoperative aid in resection.
Patients with thyroid carcinoma were identified from a retrospective database at a tertiary care center from 2011-2014. Inclusion criteria were history of thyroidectomy and/or neck dissection, non-palpable recurrent disease in the resection bed on surveillance, and ultrasound-guided needle localization of recurrent disease before resection. Perioperative data and outcomes were analyzed.
Seventeen patients were identified using the inclusion criteria listed above. Median patient age was 46 years (53% male, 47% female). A total of 23 masses in the previous operative bed were needle-localized successfully with no major long-term sequelae from this technique. The recurrent laryngeal nerve was involved with tumor in six patients. Two patients, in whom the tumor surrounded the nerve circumferentially, experienced recurrent laryngeal nerve injuries. No patients experienced postoperative hypocalcemia. With a routine surveillance and a median follow-up of 558 days, sixteen of the patients remain with no evidence of disease.
Preoperative ultrasound-guided needle localization of non-palpable recurrent operative bed disease after thyroidectomy and/or neck dissection is a potentially safe method to aid in resection and cure.
对于甲状腺癌患者，在全甲状腺切除和/或颈部清扫术后出现复发性疾病的手术管理仍然是一个具有挑战性的临床问题。再次手术会导致发病率显著增加。术前针对不可触及乳腺肿瘤的针定位技术最近已被推广应用于头颈外科手术。我们报告了术前超声引导针定位用于不可触及的手术床复发性疾病，作为术中切除辅助手段的应用情况。
从一家三级医疗中心2011 - 2014年的回顾性数据库中识别出甲状腺癌患者。纳入标准为有甲状腺切除和/或颈部清扫病史、在监测中发现手术床有不可触及的复发性疾病以及在切除前对复发性疾病进行超声引导针定位。分析围手术期数据和结果。
根据上述纳入标准确定了17例患者。患者中位年龄为46岁（男性占53%，女性占47%）。先前手术床的总共23个肿块成功进行了针定位，该技术未导致任何严重的长期后遗症。6例患者的喉返神经受累于肿瘤。2例肿瘤环绕神经的患者出现了喉返神经损伤。没有患者出现术后低钙血症。经过常规监测，中位随访558天，16例患者无疾病证据。
甲状腺切除和/或颈部清扫术后不可触及的手术床复发性疾病的术前超声引导针定位是一种有助于切除和治愈的潜在安全方法。
