介入栓塞治疗难治性Graves病临床研究

Clinical study of interventional embolization in the treatment of refractory Graves′ disease

目的:探讨甲状腺动脉栓塞治疗难治性Graves病的临床应用。方法:30例难治性Graves病患者经超选择插管至甲状腺上、下动脉造影,根据动脉管径选择不同直径的聚乙烯醇分步栓塞,并用钢圈加强。栓塞体积达80%以上。结果:30例患者栓塞术均成功。栓塞2周后,临床症状消失,甲状腺体积缩小,4周后甲状腺功能正常。随访24～40个月,26例临床治愈,无甲状腺功能减低和甲状旁腺功能减低,突眼无加重。4例复发,其中3例服抗甲状腺药物治疗,1例手术治疗。结论:介入栓塞甲状腺上、下动脉治疗难治性Graves病简单、安全、疗效显著,为Graves病治疗提供了一种有效的新方法。

Objective To study the clinical efficacy and safety of interventional embolization in the treatment of refractory Graves＇ disease. Methods Superselective arteriography and interventional embolization of superior and inferior thyroid arteries were performed with different sizes of polyvinyl alcohol particles according to the two artery diameters in 30 patients with refractory Graves＇ disease. Steel coil was added to enhance the efficacy of embolization. More than 80 percent of the thyroid gland were embolized, Results The procedures were successfully performed on all the patients. Symptoms disappeared and the sizes of thyroid glands decreased significantly after 2 weeks of embolization. The thyroid function gradually returned to normal level after 4 weeks. During 24 - 40 months of follow-up; 26 cases remained in euthyreid state without hypothyroidism and hypoparathyroidism as well as aggravation of exophthalmas whereas 4 cases recurred. 3 of them were treated with oral antithyroid therapy and the other by thyroidectomy. Conclusion The technique of embolization of superior and inferior thyroid arteries is a safe, convenient, novel, and effective therapy for the treatment of refractory Graves＇ disease.