超声引导下经皮射频消融治疗甲状旁腺腺瘤的初步临床应用

Clinical application of ultrasound-guided percutaneous radiofrequency ablation for parathyroid adenoma

目的探讨超声引导下经皮射频消融治疗甲状旁腺腺瘤的临床方案与疗效。方法对5例甲状旁腺腺瘤患者进行超声引导下单针双极式射频消融治疗,观察患者消融区超声影像的变化,对比术前、术后患者临床表现及甲状旁腺激素和血钙水平的改善情况,评估治疗的安全性与有效性。结果 5例患者均消融成功,消融造影示消融区无明显造影剂灌注,提示瘤体已丧失血供。2例患者出现声音嘶哑,但均在术后1周内恢复;未出现颈部皮下及针道出血,无甲状旁腺功能减退表现,无吞咽困难、饮水呛咳、呼吸困难等表现。术后第2天患者皮肤瘙痒、骨痛、呕吐等症状明显改善,甲状旁腺激素水平明显下降,降幅在71.4%～94.1%,血钙水平降至正常。结论超声引导下经皮射频消融治疗甲状旁腺腺瘤具有创伤小、安全性高、并发症轻微、近期疗效确切的优势。

Objective To explore the clinical strategy and efficacy of ultrasound-guided radiofrequency ablation for parathyroid adenoma. Methods Ultrasound-guided percutaneous radiofrequency ablation was used to treat 5 patients with solitary parathyroid adenomas. The ultrasonography of procedured area was closely observed. The symptoms of patients,serum parathyroid hormone （PTH） and electrolytes were compared before and after treatment, and the efficacy and safety were assessed. Results The ablative procedures were successful in all the 5 cases. Intraoperative contrast-enhanced ultrasound revealed that the previous distinct vascularities of the adenomas were completely destroyed. Hoarseness was found in two patients, and they recovered in one week postoperatively. No subcutaneous heamorrhage was found beneath the neck skin or along the puncture tract. And there were no hypoparathyroidism, dysphagia or breathing difficulties. The symptoms of ostealgia, skin itching and vomitting were greatly improved in patients on the next day of operation, with PTH obviously declined （71. 4%-94. 1%） and serum calcium returned to the normal level. Conclusion Ultrasound-guided percutaneous radiofrequency ablation is safe and effective for parathyroid adenoma, with less trauma and slight complications.