Kim Soo Young, Kim Seok-Mo, Chang Hojin, Kim Bup-Woo, Lim Chi Young, Lee Yong Sang, Chang Hang-Seok, Park Cheong Soo
Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea.
National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea.
Eur Arch Otorhinolaryngol. 2017 Sep;274(9):3497-3501. doi: 10.1007/s00405-017-4660-2. Epub 2017 Jun 29.
The standard treatment regimen for locally recurrent lesions is total thyroidectomy, or complete removal of the recurrent thyroid lesion within the thyroid bed. However, reoperation increases the risk of complications and patients have to undergo general anesthesia. Percutaneous ethanol injection therapy represents a far less invasive procedure without general anesthesia and with lower risk of complications. Thirty-four patients who received PEIT at Yonsei University Medical Center between October 2002 and August 2009 for recurrent cervical nodal metastases of differentiated papillary thyroid cancer were included in this retrospective study. During a minimum follow-up of 60 months, treatment outcomes were determined by measuring the lesion size prior to the first injection and 3 months after the last injection. A total of 46 recurrent lesions were detected in 34 patients. Five patients underwent surgery and PEIT was administered to the remaining 19 and 22 lesions in the central compartment and lateral neck lymph nodes, respectively. Size increases were observed in seven (17.1%) lesions, whereas no changes in size and decreases were detected in 10 (24.4%) and 24 (58.5%) lesions. Patients with increased lymph nodes were significantly older (65.3 ± 14.4 vs. 48.2 ± 16.3 years; p = 0.02) and had smaller sizes (9.3 ± 1.0 vs. 12.3 ± 6.4 mm; p = 0.012). Although reoperation remains the first-line treatment for recurrent thyroid cancer, PEIT may be considered as a treatment option in selected patients with lesions larger than 1 cm who are ineligible for surgery or have refused reoperation.
局部复发病变的标准治疗方案是全甲状腺切除术，即完全切除甲状腺床内复发的甲状腺病变。然而，再次手术会增加并发症风险，且患者必须接受全身麻醉。经皮乙醇注射疗法是一种侵入性小得多的手术，无需全身麻醉，并发症风险较低。本回顾性研究纳入了2002年10月至2009年8月期间在延世大学医学中心接受经皮乙醇注射疗法治疗分化型乳头状甲状腺癌颈部复发淋巴结转移的34例患者。在至少60个月的随访期间，通过测量首次注射前和最后一次注射后3个月的病变大小来确定治疗效果。34例患者共检测到46个复发病变。5例患者接受了手术，其余19个和22个病变分别在中央区和侧颈淋巴结接受了经皮乙醇注射疗法。7个（17.1%）病变出现大小增加，10个（24.4%）病变大小无变化，24个（58.5%）病变出现大小减小。淋巴结增大的患者年龄显著更大（65.3±14.4岁对48.2±16.3岁；p=0.02），且病变尺寸更小（9.3±1.0毫米对12.3±6.4毫米；p=0.012）。虽然再次手术仍然是复发性甲状腺癌的一线治疗方法，但对于病变大于1厘米、不符合手术条件或拒绝再次手术的特定患者，可考虑将经皮乙醇注射疗法作为一种治疗选择。
