超声引导下经皮细针穿刺无水乙醇治疗甲状腺腺瘤临床观察

Percutaneous ultrasound-guided fine-needle aspiration and ethanol injection for thyroid adenoma

目的探讨无水乙醇治疗孤立性良性甲状腺腺瘤的疗效。方法应用超声引导下经皮细针穿刺无水乙醇腺瘤内注射治疗甲状腺腺瘤。无水乙醇腺瘤内注射前均行细针穿刺抽取腺瘤组织液涂片送病理检查,对病理诊断为良性甲状腺腺瘤者,实质性腺瘤行腺瘤内无水乙醇注射硬化疗法,囊腺瘤者抽去囊液后行腺瘤内无水乙醇注射硬化疗法。一周一次,共约5—6次,根据腺瘤大小及缩小情况而定;本组共33例,其中单发20例,多发13例,共治疗腺瘤36个,其中实质性腺瘤21个,伴有囊性变者15个。结果 治疗前甲状腺腺瘤体积为(4.93±0.48)cm3,腺瘤囊性变结节体积为(7.89±0.91)cm3,3个月后分别缩小至(3.22±0.40)cm3及(3.85±0.55)cm3,P<0.01,随访时间越长,有效率及治愈率越高,此外,腺瘤囊性变组的结节缩小率高于实质性腺瘤组,但是,无论是否伴有囊性变,不同大小腺瘤间体积缩小率差异并不明显。本组治愈率达100%。随访1年无复发。结论超声引导下经皮细针穿刺无水乙醇注射治疗甲状腺腺瘤安全可靠,疗效肯定,不良反应少,并且对外观没影响,可作为单发性良性甲状腺腺瘤治疗的首先方法。

Objective： To investigate the value of ethanol treatment of solitary benign thyroid adenoma patients.Methods： After ultrasound-guided percutaneous fine needle aspiration,ethanol injection was done for treatment of thyroid adenoma adenoma.The tissue fluid extraction from adenoma was send to pathological examination.If adenoma were diagnosed as benign thyroid adenoma,ethanol injection sclerotherapy was done.If it was cystadenoma,the cyst fluid was removed and ethanol injection sclerotherapy was done.According to adenoma size and the narrow rate,the sclerotherapy was done once a week,about 5-6 times.In all 33 cases,there were 20 cases with single tumor and 13 cases with multiple tumors.36 adenomas were treated,including 21 substantive adenoma,those associated with cystic degeneration 15.Results： Before treatment,the volume of thyroid adenoma was（4.93±0.48） cm3,cystic adenoma nodule volume was（7.89±0.91） cm3.Three months later they were reduced to（3.22±0.40） cm3 and（3.85±0.55） cm3（P 0.01）.Longer follow-up,higher efficient and cure rate.In addition,cystic adenoma nodules group reduced substantially higher than adenomas.Whether or not accompanied with cystic change,the difference of volume reduction among different size of adenomas was not obvious.The cure rate in this group was 100%.In 1-year follow-up no recurrence occured.Conclusion： Ultrasound guided percutaneous ethanol injection treatment of thyroid adenoma is safe and effective,with less adverse reactions,and no impact on the appearance.