超声引导下射频消融治疗甲状腺良性实性结节效果观察

Therapeutic effect of ultrasound-guided radiofrequency ablation on benign solid thyroid nodule

目的探讨超声引导下射频消融(radiofrequency ablation,RFA)术治疗甲状腺良性实性结节的疗效及安全性。方法经活检组织病理证实甲状腺良性结节患者44例(64个实性结节),均于超声引导下行RFA治疗,术后即刻超声造影观察记录一次性完全消融率,分别于术前及术后1、3、6个月行超声检查并计算结节体积,观察不良反应发生情况。结果 44例RFA手术均成功,未发生严重并发症;术后即刻超声造影示一次性完全消融率为93.75%(60/64),3个结节消融不完全者超声造影指导下及时补充消融,1个结节因体积过大仅行肿瘤部分消融以减小体积,缓解压迫症状;术后3、6个月分别有2、6个结节消失,术后1、3、6个月结节体积[1.61(1.13,8.59)、0.76(0.27,4.02)、0.56(0.13,1.36)cm3]较术前[2.59(1.88,10.36)cm3]缩小(P<0.05);术后即时彩色多普勒示结节内部未见明显血流信号。结论超声引导下RFA术治疗甲状腺良性实性结节安全、有效,超声造影在RFA治疗及随访中有重要价值。

Objective To investigate the safety and efficacy of ultrasound-guided radiofrequency ablation （RFA） for benign solid thyroid nodule. Methods Forty-four patients （64 solid nodules） with histopathologically confirmed benign thyroid nodules received ultrasound-guided RFA treatment. The complete ablation rate for once was recorded immediately after operation with contrast-enhanced ultrasound. The nodule sizes were detected and calculated before operation, and 1, 3 and 6 months after operation with ultrasound. The incidence of adverse reactions was observed. Results All these 44 cases were successfully performed RFA with no serious complications. Contrast-enhanced ultrasound showed the complete ablation rate for once immediately after operation was 93.75% （60/64）. Three nodules of incomplete ablation received ultrasound-guided ablation again. The left one nodule only received partial ablation for alleviating compression symptom due to its large size. Two nodules disappeared 3 months after operation and 6 nodules disappeared 6 months after operation. The sizes of nodule were smaller 1, 3 and 6 after operation （1.61（1. 13,8.59）, 0. 76（0. 27,4.02）, 0. 56 （0.13,1.36） cm3） than before operation （2. 59（1.88,10. 36） cm3） （P〈0.05）. Color Doppler ultrasound showed no hlood flow signal. Conclusion Ultrasound-guided RFA is safe and effective for benign solid thyroid nodule. Contrast- enhanced ultrasound plays an important role in the treatment and prognosis of RFA.