协和医学杂志

2015, v.6(05) 338-342

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

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;
WU Qiong;FANG Shi-bao;LI Xiao-yi;LIU Hong-feng;CHEN Ge;YANG Xiao;ZHU Shen-ling;JIANG Yu-xin;ZHAO Rui-na;XIA Yu;YANG Meng;ZHANG Qing;WANG Liang;LI Wen-bo;ZHANG Bo;Department of Ultrasound,The Affiliated Hospital of Qingdao University;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

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。
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 underwent 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 theultrasonic 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 sensitivity 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 surgeons. 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 ultrasonic features.

关键词(KeyWords): 甲状腺癌;手术;淋巴结;超声;定位
thyroid carcinoma;surgery;lymph node;ultrasonography;localization

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作者(Author): 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;
WU Qiong;FANG Shi-bao;LI Xiao-yi;LIU Hong-feng;CHEN Ge;YANG Xiao;ZHU Shen-ling;JIANG Yu-xin;ZHAO Rui-na;XIA Yu;YANG Meng;ZHANG Qing;WANG Liang;LI Wen-bo;ZHANG Bo;Department of Ultrasound,The Affiliated Hospital of Qingdao University;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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