Zheng Bo-Wen, Wu Tao, Yao Zhi-Cheng, Ma Yan-Ping, Ren Jie
Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
Department of General Surgery, The Third Affiliated Hospital of Sun Yat-sen university, Guangzhou 510530, Guangdong Province, China.
World J Clin Cases. 2022 Oct 16;10(29):10755-10762. doi: 10.12998/wjcc.v10.i29.10755.
Hydrodissection is a widely used technique during radiofrequency ablation (RFA) for benign thyroid nodules. Although it could effectively avoid thermal injury to the surrounding critical structures and achieve complete treatment, routine operation of the remaining needle could cause perithyroidal hemorrhage. In this report, we present 2 cases of perithyroidal hemorrhage during RFA caused by a hydrodissection needle, which have not been reported before.
A 21-year-old female and a 45-year-old male were admitted for RFA for benign thyroid nodules. Considering that their nodules were adjacent to the recurrent laryngeal nerve, the needle used for hydrodissection was placed and remained between the dorsal capsule of the lateral lobe and the recurrent laryngeal nerve. During the procedure, active bleeding near the needle appeared on ultrasonography (US). Although moderate pressure was quickly applied to the neck for several minutes, contrast-enhanced US (CEUS) still showed an active hemorrhage. A radiofrequency electrode was placed at the bleeding point under the guidance of CEUS to stop the bleeding, and the procedure was finally confirmed to be successful by CEUS, without other complications.
Hydrodissection during RFA of benign thyroid nodules was associated with a risk of perithyroidal hemorrhage. The timely recognition of this acute hemorrhage could help in the timely control of the bleeding, and CEUS-guided ablation of the bleeding point could be useful.
水分离术是射频消融（RFA）治疗良性甲状腺结节时广泛应用的技术。尽管它能有效避免对周围重要结构的热损伤并实现彻底治疗，但剩余穿刺针的常规操作可能导致甲状腺周围出血。在本报告中，我们呈现2例射频消融期间由水分离针导致的甲状腺周围出血病例，此前未见报道。
一名21岁女性和一名45岁男性因良性甲状腺结节接受射频消融治疗。考虑到他们的结节靠近喉返神经，用于水分离的穿刺针放置并保留在侧叶背膜与喉返神经之间。手术过程中，超声检查（US）显示穿刺针附近出现活动性出血。尽管迅速对颈部施加适度压力几分钟，但对比增强超声（CEUS）仍显示有活动性出血。在CEUS引导下将射频电极置于出血点以止血，最终经CEUS确认手术成功，无其他并发症。
良性甲状腺结节射频消融期间的水分离术存在甲状腺周围出血风险。及时识别这种急性出血有助于及时控制出血，CEUS引导下对出血点进行消融可能有效。
