超声引导射频消融甲状腺良性结节的风险评估与对策研究

Risk assessments and countermeasures on ultrasound-guided radiofrequency ablation for benign thyroid nodules

目的 探讨超声引导甲状腺良性结节射频消融术前风险评估的意义及预防对策.方法 274例311个甲状腺良性实性结节治疗前根据消融风险由低到高分为0～Ⅳ级,其中0级38个,Ⅰ级69个,Ⅱ级36个,Ⅲ级59个,Ⅳ级109个.用连续移动法或多平面组合法消融,用“杠杆撬离法”或“液体隔离带法”预防热损伤毗邻结构.结果 311个甲状腺结节均完全消融.59个Ⅲ级风险结节中30个用“杠杆撬离法”均有效避免了热损伤;29个用“液体隔离带法”预防,2例发生喉返神经损伤,两种方法对Ⅲ级风险的预防效果比较差异无统计学意义（P=0.237）.109个Ⅳ级风险结节中102个用“杠杆撬离法”、7个用“液体隔离带法”预防,发生喉返神经损伤分别有1例、2例,两种方法对Ⅳ级风险的预防效果比较差异有统计学意义（P=0.010）.143个0～Ⅱ级风险结节消融时未损伤毗邻结构.结论 甲状腺结节射频消融术前风险评估有助于并发症的预防.“杠杆撬离法”能有效预防热损伤毗邻结构,且操作简便,有一定的应用价值.

Objective To investigate the value of preoperative risk assessments and countermeasures on ultrasound-guided radiofrequency ablation for benign thyroid nodules.Methods The preoperative risk assessments of 311 benign solid thyroid nodules in 274 patients were divided into level 0-Ⅳ,among which 38 nodules on level 0,69 nodules on level Ⅰ,36 nodules on level Ⅱ,59 nodules on level Ⅲ,109 nodules on level Ⅳ.Treatments were performed by moving shot technique or multiplanar shot technique,using “Leverage Displacement” or “Hydrodissection” to prevent the adjacent vital structures from thermal injuries.Results 311 thyroid nodules were completely ablated.In ablating the 59 nodules on risk level Ⅲ,thermal injuries were effectively avoided in 30 cases by using“Leverage Displacement”,while recurrent laryngeal nerve injuries happened in 2 cases using “Hydrodissection” for 29 nodules.The difference between these two methods on risk level Ⅲ had no statistical significance（P =0.237）.To avoid thermal injuries during ablation for 109 nodules on risk level Ⅳ,using“Leverage Displacement” for 102 nodules,recurrent laryngeal nerve injuries happened in 1 case,while using “Hydrodissection”for 7 nodules,recurrent laryngeal nerve injuries happened in 2 cases.The difference between the two methods on risk level Ⅳ had statistical significance（P =0.010）.No thermal injury happened during ablation for 143 nodules on risk level 0-Ⅱ.Conclusions Preoperative risk assessment on thyroid nodules is helpful in preventing potentially avoidable complications.Proper use of “Leverage Displacement” can protect adjacent vital structures from thermal injuries during ablation for nodules,which is easy and simple to handle and has a certain practical application value.