Xie Tianhao, Fu Yan, Jin Xiaoshi, Ren Xiangxiang, Zhang Jing, Sun Qian
Department of General Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei, China.
Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China.
Front Endocrinol (Lausanne). 2025 Jun 4;16:1607214. doi: 10.3389/fendo.2025.1607214. eCollection 2025.
To synthesize evidence on Horner syndrome (HS) as a complication of ultrasound-guided ablation therapy for thyroid nodules, including its incidence, mechanisms, risk factors, and prevention strategies, to enhance ablation safety and guide future research.
Web of Science, PubMed, Cochrane Library, and Embase.
Based on the framework of the PRISMA-ScR, a search was conducted in databases up to December 31, 2024.
Twelve articles were included, covering Microwave Ablation (MWA), Radiofrequency Ablation (RFA), High-Intensity Focused Ultrasound (HIFU), and Percutaneous Ethanol Injection (PEI). HS incidence rates varied: MWA 0.4%-4.2%, RFA 0.1%-1.5%, HIFU 1.5%-6.7%, with PEI incidence unspecified due to insufficient data. HS mechanisms included thermal injury to the cervical sympathetic chain, nerve damage from ethanol extravasation, and mechanical compression. Risk factors included ablation zones adjacent to the middle cervical ganglion (MCG), improper ablation parameter settings (such as excessively high power or prolonged duration), and nodule locations near the inferior thyroid artery. Prevention strategies emphasized precise preoperative ultrasound localization of the CSC and MCG, optimization of the isolation belt technique, timely adjustment of ablation parameters, real-time monitoring of symptoms, and avoiding the ablation probe tip from extending beyond the nodule edge.
HS is a rare but serious complication with varying incidence rates by technique. Risk can be reduced through precise assessment, meticulous techniques, and technological innovations. Future prospective studies are needed to clarify incidence rates, long-term prognosis, and refine clinical practice guidelines.
综合关于霍纳综合征（HS）作为甲状腺结节超声引导下消融治疗并发症的证据，包括其发生率、机制、危险因素及预防策略，以提高消融安全性并指导未来研究。
科学网、PubMed、Cochrane图书馆和Embase。
基于PRISMA-ScR框架，对截至2024年12月31日的数据库进行检索。
纳入12篇文章，涵盖微波消融（MWA）、射频消融（RFA）、高强度聚焦超声（HIFU）和经皮乙醇注射（PEI）。HS发生率各不相同：MWA为0.4%-4.2%，RFA为0.1%-1.5%，HIFU为1.5%-6.7%，由于数据不足，PEI的发生率未明确。HS的机制包括颈交感神经链热损伤、乙醇外渗导致的神经损伤和机械压迫。危险因素包括消融区邻近颈中神经节（MCG）、消融参数设置不当（如功率过高或持续时间过长）以及结节位于甲状腺下动脉附近。预防策略强调术前对颈交感神经链（CSC）和MCG进行精确的超声定位、优化隔离带技术、及时调整消融参数、实时监测症状以及避免消融探头尖端超出结节边缘。
HS是一种罕见但严重的并发症，不同技术的发生率各异。通过精确评估、细致技术和技术创新可降低风险。未来需要进行前瞻性研究以明确发生率、长期预后并完善临床实践指南。
