Graves病介入栓塞治疗的病理研究

Pathology of thyroid arterial embolisation to treat hyperthyroidism caused by Graves' disease

目的观察Graves病栓塞后的甲状腺组织动态病理变化。方法15例甲状腺动脉150 mm聚乙烯醇（PVA）微粒及平阳霉素栓塞治疗的Graves病患者,于术前、术后7天、3个月、6个月、1年、3年分别行甲状腺穿刺活检,共行44次穿刺活检,其中动脉栓塞术前15例、栓塞术后7天2例、3个月3例、6个月6例、1年5例次、3年13例次。结果栓塞后7天主要表现为凝固性坏死;栓塞后3-6个月表现为纤维组织增生变性和淋巴细胞浸润,滤泡灶性坏死为主;栓塞后1-3年主要表现为间质纤维组织增生明显和滤泡萎缩,部分散在增生滤泡被纤维间质分隔包裹,难以形成腺小叶结构,滤泡周围血管网减少。结论经甲状腺动脉栓塞治疗Graves病,甲状腺组织的病理变化是在栓塞后近期内主要表现为急性缺血坏死,然后表现为持续的慢性炎性破坏、滤泡萎缩、部分滤泡增生被明显增生的纤维组织分隔包裹的变化过程。提示微循环栓塞能肯定地破坏甲状腺组织,达到治疗Graves病较好的疗效。

Objective To study histopathological changes of thyroid tissues after thyroid arterial embolisation to treat hyperthyroidism caused by Graves＇ disease through observing its histopathological changes. Methods Fifteen patients of Graves＇ disease treated through transcathter arterial embolisation with polyvinyl alcohol （PVA） microparticle which diameter was 150 mm. Forty-four patients underwent needle aspiration biopsy of the thyroid gland： 15 cases, 2 cases, 3 cases, 6 cases, 5 cases, 13 cases respectively before thyroid arterial embolisation, 7 days, 3 months, 6 months, 1 year, 3 years after thyroid arterial embolisation. Results There were small ischemia sections on background of trauma of gland tissue and ischemia after thyroid arterial embolisation. There were a few blood enrichment spots on background of ischemia. The change of histopathology were different with different case at the same period. The change of histopathology mainly showed coagulation necrosis 7 days after thyroid arterial embolisation, fibrous hyperplasia 3-6 months because of lack of blood after thyroid arterial embolisation and mesenchyma hyperplasia and follicle atrophy 1-3 years after thyroid arterial embolisation. Conclusion Histopathology is transformation process of acute infarction, fibrous hyperplasia, follicle atrophy, a few follicle hyperplasia encapsulated fibrous. This indicate microcirculatory embolism can destroy the tissue of thyroid and the thyroid artery embolisation is a effective therapy for Graves＇ disease.