超声引导下导丝定位在甲状腺癌术后复发转移淋巴结再次手术中的应用价值

Clinical value of ultrasound-guided guidewire localization in reoperation for recurrent metastatic lymph nodes after thyroid cancer surgery

摘要:

背景与目的 甲状腺癌术后颈部淋巴结复发患者再次手术难度较大，存在术区瘢痕粘连重、解剖层次不清及并发症发生率较高等问题。传统超声体表定位难以实现术中精准定位。本研究比较超声引导下导丝定位与超声体表定位在甲状腺癌术后复发淋巴结切除中的应用效果，评估导丝定位技术的安全性与临床价值。方法 回顾性分析2023年5月—2025年5月于哈尔滨医科大学附属肿瘤医院接受再次手术治疗的27例甲状腺癌术后颈部淋巴结复发转移患者的临床资料。其中，12例采用超声引导下导丝定位（导丝定位组），15例采用超声体表定位（体表定位组）。比较两组围手术期指标、阳性淋巴结检出情况及术后并发症发生情况。结果 在颈侧区及中央区手术患者中，导丝定位组手术时间及术中出血量均明显低于体表定位组（均P<0.05）。在颈侧区手术患者中，导丝定位组术后引流量低于体表定位组（P<0.05），而中央区患者两组术后引流量差异无统计学意义（P>0.05）。导丝定位组12例患者35枚淋巴结中共检出阳性淋巴结20枚（20/35），阳性淋巴结比例为57.14%；体表定位组14例患者52枚淋巴结中共检出阳性淋巴结22枚（22/52），阳性淋巴结比例为42.31%，差异有统计学意义（P=0.019）。导丝定位组并发症发生率为16.67%，体表定位组为20.00%，差异无统计学意义（P>0.05）。术后3个月随访中，体表定位组1例患者仍存在可疑残余淋巴结。结论 超声引导下导丝定位可提高甲状腺癌术后复发淋巴结的术中定位准确率，缩短手术时间，减少术中出血及组织分离范围，并有助于提高阳性淋巴结检出率，具有良好的安全性和临床应用前景。

Abstract:

Background and Aims Reoperation for recurrent cervical lymph node metastasis after thyroid cancer surgery is technically challenging because of postoperative scar adhesion, distorted anatomy, and an increased risk of complications. Conventional ultrasound-guided surface marking has limited accuracy in intraoperative localization. This study aimed to compare the efficacy and safety of ultrasound-guided guidewire localization and ultrasound-guided surface marking in the surgical management of recurrent lymph nodes after thyroid cancer surgery.Methods Clinical data of 27 patients with recurrent cervical lymph node metastasis after thyroid cancer surgery who underwent reoperation at Harbin Medical University Cancer Hospital between May 2023 and May 2025 were retrospectively analyzed. Twelve patients underwent ultrasound-guided guidewire localization (guidewire group), and 15 patients underwent ultrasound-guided surface marking (surface-marking group). Perioperative outcomes, metastatic lymph node detection, and postoperative complications were compared between the two groups.Results In both the lateral neck and central compartment subgroups, operative time and intraoperative blood loss were significantly lower in the guidewire group than in the surface-marking group (all P<0.05). In patients undergoing lateral neck dissection, postoperative drainage volume was significantly lower in the guidewire group (P<0.05), whereas no significant difference was observed in the central compartment subgroup (P>0.05). A total of 20 metastatic lymph nodes were identified among 35 dissected lymph nodes in the guidewire group, with a positive lymph node rate of 57.14%, compared with 22 positive lymph nodes among 52 dissected lymph nodes in the surface-marking group, yielding a positive lymph node rate of 42.31% (P=0.019). The postoperative complication rates were 16.67% and 20.00% in the guidewire and surface-marking groups, respectively, without significant difference (P>0.05). During the 3-month follow-up, suspicious residual lymph nodes were detected in one patient in the surface-marking group.Conclusion Ultrasound-guided guidewire localization improves the accuracy of intraoperative localization for recurrent metastatic lymph nodes after thyroid cancer surgery, shortens operative time, reduces intraoperative blood loss and tissue dissection, and may improve metastatic lymph node detection rates. This technique is safe and shows promising clinical application value.