超声引导下射频消融治疗甲状腺微小乳头状癌的临床体会

Experience of Radiofrequency Ablation Treatment of Thyroid Papillary Micro-carcinoma Under Ultrasound Guidance

目的：总结超声引导下射频消融治疗甲状腺微小乳头状癌的临床经验和体会。方法（1）病例选择：超声检查疑为甲状腺微小乳头状癌（病灶最大直径小于10 mm），且患者希望首选非手术治疗者。共选取9例患者，11个病灶。（2）方法：治疗前先行病灶的组织学穿刺活检，之后在超声引导下进行甲状腺病灶的射频消融治疗，射频消融治疗后应用超声造影进行定期随访。结果（1）所有病例治疗后恢复顺利，未出现并发症；（2）11个病灶的病理诊断中，7个为甲状腺乳头状癌，4个未见确切癌组织；（3）所有病例得到随访，随访时间12～18个月。超声造影显示消融区域范围缩小，甲状腺及引流区域淋巴结未见甲状腺癌复发和其他异常的影像学表现。结论（1）射频消融可作为治疗无淋巴结转移的甲状腺微小乳头状癌的一种安全、有效的方法；（2）由于射频消融微创、安全、有效，对于影像学高度怀疑甲状腺病灶恶性可能，即使无病理学诊断支持，仍是射频消融治疗的适应证之一；（3）本组病例射频消融治疗后是否存在癌组织残留及淋巴结微转移等问题，有待更长时间的随访资料。

Objective To summarize the clinical experience of radiofrequency ablation （ RFA） treatment of thyroid papillary micro -carcinoma under ultrasound guidance .Methods （1）9 patients, with 11 lesions, were recruited with ultrasonography diagnosis of thyroid micro-carcinoma （less than 10 mm in diameter）, who were anxious about the mass but non -acceptance of surgery.（2）Core needle his-tological biopsy was done before RFA;then the lesions were treated by RFA under ultrasound guidance .All the patients were followed up by ultrasound scan.Results （1）All patients recovered with no FRA related complications .（2）Seven lesions was pathologically diagnosed as thyroid papillary carcinoma , and in four lesions tumor cells weren′t pathologically found .（ 3 ） All cases were followed up from 12 to 18 months.Post ablated lesions became smaller and smaller during follow -up, and diminished within 6 months.There was no abnormal ima-ging which was considered recurrence in both thyroid and lymph nodes .Conclusion （1）RFA could be considered as a safe and effective method in treating papillary micro -carcinoma of thyroid.（2）Due to the advantages of safety and minimally invasion of RFA , thyroid le-sions, which were highly suspected malignant, was one of the indications of RFA, even if there was no pathological confirmation.（3）Long time follow-up are needed to observe the effect and side -effect of FRA.