Graves病介入治疗的病理及临床研究

The pathologic basis and clinical experience of interventional embolization in treatment of Graves disease

目的 探讨难治性Graves病介入栓塞治疗的临床疗效、安全性及栓塞后甲状腺病理形态变化。方法 2 2例难治性Graves病 ,经超选择插管至甲状腺上、下动脉 ,使用聚乙烯醇或白芨微球栓塞治疗 ,观察栓塞后临床症状及甲状腺大小的变化。对其中 6例伴巨大甲状腺者 ,栓塞后行手术治疗并观察栓塞后甲状腺病理形态变化。结果 6例栓塞 2～ 3周后行双侧甲状腺次全切除 ,手术顺利 ,临床治愈。未手术的 16例 ,除 2例尚需分别用他巴唑 5～ 10mg/d或丙基硫氧嘧啶 5 0～ 10 0mg/d治疗外 ,14例均获治愈。随访 3～ 30个月 ,甲状腺功能正常 ,甲状腺明显缩小 ,无严重并发症。甲状腺病理切片示甲状腺上、下动脉及其微细分支大部分闭塞、机化 ,相应甲状腺组织发生化学性炎症性坏死及纤维化。结论 介入栓塞甲状腺上、下动脉 ,可使Graves病临床治愈 ,为Graves病的治疗或作术前准备提供了一种有效的新方法。

Objective To study the clinical effects, safety and histopathology of the thyroid after interventional embolization in the treatment of refractory Graves disease. Methods Superselective arteriography and interventional embolization of thyroid superior and inferior arteries were performed by polyvinyl alcohol and Bletilla microspheres in 22 patients with refractory Graves disease. Pathological morphology of thyroid glands was observed in 6 patients with huge goiter who received subtotal thyroidectomy after embolization. Results Six patients were cured by subtotal thyroidectomy 2-3 weeks after embolization. The remaining 16 cases were treated only with interventional embolization, of whom, 14 were cured, the other 2 patients were still on maintaining dosage of antithyroid drug therapy (Tapazole 5-10 mg/d or PTU 50-100 mg/d). Followed up by 3-30 months, all patients remained in euthyroid state and the size of thyroid glands decreased remarkably to at least 1/3-1/2 of its original volume. No serious complications were found. Pathological examination showed that the superior and inferior thyroid arteries and most of their branches were embolized. Chemical inflammation, necrosis and fibrosis were observed in embolized thyroid tissue. Conclusion The technique of embolization of superior and inferior thyroid arteries is a new effective method for the treatment of refractory Graves disease as well as a pre operative procedure in some cases.