巨大结节性甲状腺肿术前介入栓塞的临床应用

The clinical application of interventional treatment before operation in nodular goiter(giga-type)

目的评价介入后再手术治疗结节性甲状腺肿(巨大型)的疗效与安全性。方法应用Seldinger技术,通过股动脉穿刺将5F猎人头导管或sp微导管超选择性插入甲状腺上动脉,做患侧甲状腺选择性动脉造影,然后注入下1mm明胶海绵颗粒进行栓塞,介入治疗,1周后行手术切除。结果介入治疗后,4例肿块体积缩小≥40%,3例肿块体积缩小≥30%,增粗的血管已扁平或闭塞,甲状腺组织切面苍白、质韧,术中出血极少。术后随访6个月～1年,无一例患者出现喉上及喉返神经损伤、甲状腺危象、甲状旁腺损伤、继发性甲状腺功能低下等并发症,均治愈,未见复发。结论该方法安全、有效,并发症少,治愈率高,值得临床进一步实践。

Objective To evaluate the therapeutic effect and safety of nodular goiter （giga-type） operation after intervention therapy. Methods 5F-type catheter or sp micro-catheter was catheterized selectively into upper thyroid artery using Seldinger technique through femoral artery. The thyroid artery was embolized with gelatin sponge particles after ipsilateral thyroid arteriography, tand thyreoidectomy was performed 1 week later. Results After the interventi on therapy, the size of the tumor deflated over 40% in 4 cases, and over 30% in 3 cases. The thickening blood vessels became thin and flat or obstruction, and thyroid tissue cross-section became pale and tenacious. There was little bleeding during the operation. No patient appeared the damage of laryngeal nerve or parathyroid body, the secondary hypothyroidism or thyroid crisis during six months to one year follow-up. Conclusion It is a safe, effect method with few complications and high cure rate to operating after thyroid artery embolization, and is worth to be practiced further in clinic.