CAJ | 학술논문

甲状腺癌淋巴结清扫术前超声定位的作用
갑상선암림파결청소술전초성정위적작용
Role of Preoperative Localization with Ultrasound in Thyroid Carcinoma Neck Lymphadenectomy

万方数据

协和医学杂志協和醫學雜誌 협화의학잡지
Medical Journal of Peking Union Medical College Hospital
2015年 5期 338-342 ,共5页

吴琼%房世保%李小毅%刘洪枫%陈革%杨筱%朱沈玲%姜玉新%赵瑞娜%夏宇%杨萌%张青%王亮%李文波%张波

오경%방세보%리소의%류홍풍%진혁%양소%주침령%강옥신%조서나%하우%양맹%장청%왕량%리문파%장파

甲状腺癌%手术%淋巴结%超声%定位甲狀腺癌%手術%淋巴結%超聲%定位
갑상선암%수술%림파결%초성%정위
thyroid carcinoma%surgery%lymph node%ultrasonography%localization

目的：探讨甲状腺癌淋巴结清扫术前淋巴结超声定位的作用。方法回顾性分析2012年1月至2015年5月在北京协和医院行甲状腺癌颈部淋巴结清扫术并行术前超声淋巴结定位的38例患者(共89个淋巴结)的临床及超声资料,分析转移性淋巴结的部位、超声特征及其在诊断转移性淋巴结中的价值。结果89个术前超声定位淋巴结的短径平均为(0．59±0．25) cm,23个(25．9%)位于颈部Ⅱ区,25个(28．1%)位于Ⅲ区,17个(19．1%)位于Ⅳ区,5个(5．6%)位于Ⅴ区,19个(21．3%)位于Ⅵ区。经手术病理证实,89个定位淋巴结中,80个为淋巴结,其中60个为转移性,20个为非转移性(8个炎性淋巴结,12个正常淋巴结)；6个对应区域内未切除淋巴结；2个为纤维、神经组织；1个为胸腺组织。比较转移性和非转移性淋巴结的超声特征,发现血流信号杂乱在两组间差异有统计学意义(46．67%比5．00%, P=0．001),其诊断转移性淋巴结的敏感性为46．67%,特异性为95．00%；其余特征包括淋巴结短径≥1 cm、短径/长径≥0．5、皮髓质分界不清、皮质增厚、皮质内无回声、皮质内强回声、皮质内高回声、外周型血流信号及血流信号丰富在两组之间差异均无统计学意义。结论术前超声定位的淋巴结通常较小,临床不易触诊,术前定位能够指导外科医生更加精确地确定手术范围,为靶向切除转移性淋巴结提供更精准的依据。淋巴结内血流信号杂乱是超声鉴别转移性淋巴结特异性较高的指标,结合其他超声特征对指导淋巴结定位具有重要作用。
목적：탐토갑상선암림파결청소술전림파결초성정위적작용。방법회고성분석2012년1월지2015년5월재북경협화의원행갑상선암경부림파결청소술병행술전초성림파결정위적38례환자(공89개림파결)적림상급초성자료,분석전이성림파결적부위、초성특정급기재진단전이성림파결중적개치。결과89개술전초성정위림파결적단경평균위(0．59±0．25) cm,23개(25．9%)위우경부Ⅱ구,25개(28．1%)위우Ⅲ구,17개(19．1%)위우Ⅳ구,5개(5．6%)위우Ⅴ구,19개(21．3%)위우Ⅵ구。경수술병리증실,89개정위림파결중,80개위림파결,기중60개위전이성,20개위비전이성(8개염성림파결,12개정상림파결)；6개대응구역내미절제림파결；2개위섬유、신경조직；1개위흉선조직。비교전이성화비전이성림파결적초성특정,발현혈류신호잡란재량조간차이유통계학의의(46．67%비5．00%, P=0．001),기진단전이성림파결적민감성위46．67%,특이성위95．00%；기여특정포괄림파결단경≥1 cm、단경/장경≥0．5、피수질분계불청、피질증후、피질내무회성、피질내강회성、피질내고회성、외주형혈류신호급혈류신호봉부재량조지간차이균무통계학의의。결론술전초성정위적림파결통상교소,림상불역촉진,술전정위능구지도외과의생경가정학지학정수술범위,위파향절제전이성림파결제공경정준적의거。림파결내혈류신호잡란시초성감별전이성림파결특이성교고적지표,결합기타초성특정대지도림파결정위구유중요작용。
Objective To explore the role of preoperative localization of lymph nodes with ultrasound in thyroid carcinoma neck lymphadenectomy. Methods Altogether 38 patients (89 located lymph nodes) who un-derwent thyroid carcinoma neck lymphadenectomy and preoperative localization of lymph nodes with ultrasound in the period from January 2012 to May 2015 in Peking Union Medical College Hospital were enrolled in this study. The location and the ultrasonic features of metastatic lymph nodes were retrospectively analyzed, the value of the ultrasonic features in diagnosis of metastatic lymph nodes was also evaluated. Results The short-axis diameter of the 89 lymph nodes located with ultrasound was (0. 59 ± 0. 25) cm. Twenty-three lymph nodes (25. 9%) were located in level Ⅱ, 25 ( 28. 1%) in level Ⅲ, 17 ( 19. 1%) in level Ⅳ, 5 ( 5. 6%) in level Ⅴ, and 19 ( 21. 3%) in level Ⅵ. Surgery pathological findings confirmed that 80 of the 89 located lymph nodes were lymph nodes, of which 60 were metastatic and 20 were non-metastatic (8 inflammatory and 12 normal) . No lymph node was found in the corresponding levels of 6 located lymph nodes. Two of the located lymph nodes were diagnosed as fibrous and nervous tissues and one as thymus tissue. There was significant difference in disordered blood flow between metastatic lymph nodes and non-metastatic lymph nodes (46. 67% vs. 5. 00%, P=0. 001). The sensi-tivity and specificity of disordered blood flow in diagnosing metastatic lymph nodes were 46. 67% and 95. 00%, respectively. There was no significant difference in short-axis diameter (≥1 cm) , short-to-long axis ( S/L) ratio (≥0. 5), unclear corticomedullary differentiation, thickened cortex, anechoic, strong echoic, and hyperechoic areas in cortex, peripheral blood flow or abundant blood flow between metastatic and non-metastatic lymph nodes. Conclusions The lymph nodes located with preoperative ultrasound are usually too small to be palpated by sur-geons. Preoperative localization with ultrasound of lymph nodes could guide the scope of operation and targeted dissection of metastatic lymph nodes. The disordered blood flow is specific in diagnosing metastatic lymph nodes, which could play an important role in preoperative localization of lymph nodes when combined with other ultrason-ic features.