液体隔离带在超声引导穿刺颈部高风险病灶中的应用

目的评估液体隔离带在超声引导穿刺颈部高风险病灶中的可行性、安全性及有效性。方法 2013年7-12月在同济大学附属第十人民医院暨上海市第十人民医院行注射液体隔离带辅助超声引导下经皮颈部穿刺的30例患者32个病灶。穿刺前注射液体隔离带,观察液体隔离带操作成功率、注入后效果及并发症。结果注射液体隔离带操作需1-2 min,注入0.9%氯化钠溶液10-20 ml。注射液体隔离带成功率为97%（31/32）。其中1例不成功者为甲状腺癌术后复发患者,复发的甲状腺癌灶与颈动脉粘连紧密,无法成功分离。28个紧邻血管或穿刺路径上有血管阻断的病灶中,27个病灶（96%,27/28）成功与血管分离或使血管远离穿刺路径;7个靠近喉返神经走行区的病灶中,全部成功远离喉返神经走行区。所有病例均未出现与注射液体隔离带相关的并发症,成功注射液体隔离带后穿刺成功率为100%,均未损伤血管、喉返神经或邻近组织结构。结论液体隔离带的应用使没有穿刺路径的颈部病灶具备了穿刺条件,降低了危险区域的穿刺风险,尤其提高了紧邻大血管及喉返神经的甲状腺结节或甲状旁腺热消融的安全性,从而拓宽了穿刺的适应证,使部分高风险病例获得了穿刺活检或穿刺治疗的机会。

Application of hydrodissection in percutaneous puncture of neck lesions with high risk under ultrasound guidance

Objective To assess the feasibility,safety and usefulness of hydrodissection in high risk ultrasound-guided puncture procedure of neck lesions.Methods From July 2013 to December 2013,hydrodissections were applied in 32 lesions of 30 patients before ultrasound-guided puncture procedures in the Department of Medical Ultrasound,Shanghai Tenth People＇s Hospital.The effect of hydrodissection,complications and the success rate were assessed.Results The technical success rate of hydrodissection was 97%（31/32）.The only failure case was a postoperative recurrence patient,whose lesion cannot be separated successfully since it was closed to the carotid artery.Most lesions（96%,27/28） were successfully separated from the blood vessels,which were located in the route of ultrasound-guided puncture procedure or closed to the lesions.All lesions（100%,7/7） located adjacent to the recurrent laryngeal nerve were successfully separated from the recurrent laryngeal nerve after the application of hydrodissection.No complication related to hydrodissection occurred.After the application of hydrodissection,the success rate of ultrasound-guided puncture procedures was 100% without the injury of blood vessel,recurrent laryngeal nerve and adjacent tissue.Conclusion The application of hydrodissection makes it possible to puncture the lesions without puncture path at first.In addition,this procedure reduces the risk of complex puncture and improves the safety of thermal ablation for thyroid or parathyroid nodules adjacent to the great vessels and laryngeal recurrent nerve.It expands the indications of punctures of high risk neck lesions and offers more treatment opportunities to these high risk cases.