介入栓塞治疗难治性Graves病的临床应用与病理机制

Clinical Experiences and Pathological Mechanism of Interventional Embolization in the Treatment of Refractory Graves Disease

【目的】观察介入栓塞治疗难治性Graves病的临床疗效及甲状腺病理形态变化 ,探讨其病理机制 ,为临床提供治疗依据及应用经验。【方法】采用Seldinger技术 ,选择性插管至甲状腺动脉 ,注入栓塞剂治疗 2 0例难治性Graves病 ,并观察伴巨大甲状腺、经栓塞后行手术治疗者的甲状腺病理形态变化。【结果】① 6例栓塞 2～ 3周后行双侧甲状腺次全切 ,手术顺利 ,临床治愈 ;未有手术的 14例 ,除 2例尚需分别用他巴唑 (tapazole) 5～ 10mg/d或丙硫氧嘧啶 (PTU) 5 0～ 10 0mg/d治疗外 ,12例均获治愈。随访 6～ 36月 ,甲状腺功能正常 ,甲状腺明显缩小 ,无严重并发症。②甲状腺病理切片示甲状腺上、下动脉及其微细分支大部分栓塞、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】介入栓塞治疗后的临床变化及病理切片血管及甲状腺组织结构的改变 ,说明该法能使Graves病临床治愈 ,是治疗Graves病或作术前准备另一有效的新方法。

Objective To observe the clinical effects and pathological thyroid morphology of interventional embolization in the treatment of refractory Graves disease, in order to study its pathological mechanism and provide supporting evidences for treatment and experiences for clinical application. Methods Selective arteriography and interventional embolization of thyroid arteries were performed by Seldinger technique in 20 patients with refractory Graves disease. Pathological morphology of thyroid glands was observed in those patients with huge goiter who received subtotal thyroidectomy after embolization. Results ①Six patients were cured by subtotal thyroidectomy 2～3 weeks after embolization. The remaining 14 cases were treated only with interventional embolization. Of whom 12 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 6～36 months, all patients remained on euthyroid state and the size of thyroid glands decreased remarkably by at least 1/3～1/2 of its original volume. No serious complications were found. ②Pathological examination of thyroid glands showed that 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 clinical effects and pathological morphology of thyroid glands after embolization indicate that interventional embolic technique is a new effective method for the treatment of refractory Graves disease and preparation for operation in clinical practice.