超声引导下微波消融治疗甲状腺良性结节37例报告

Ultrasound-guided Microwave Ablation for Benign Thyroid Nodules: Report of 37 Cases

目的探讨超声引导下微波消融(microwave ablation,MWA)治疗甲状腺良性结节的临床效果。方法 2014年10月~2015年2月采用移动单元消融技术对37例59枚甲状腺良性结节行超声引导MWA。颈部皮肤取l mm切口,切开皮肤及皮下组织,将微波针穿刺在甲状腺结节内开启微波,甲状腺结节的消融采用"移动单元"消融法。术后1、3、6个月观察结节消融区体积、体积缩小率、结节最大径、甲状腺功能及并发症。结果 37例59枚甲状腺结节MWA过程顺利,无中转开放手术。19例术后颈部有胀痛感,次日明显减轻。术后放射性耳根痛3例,持续2~3 d疼痛自行缓解。喉返神经损伤2例,术后4个月患者声音恢复正常。无颈部皮肤烧伤、出血和感染发生。术后6个月甲状腺结节体积(0.86±0.25)cm^3,明显小于术前(3.49±0.27)cm3(q=60.269,P<0.05)。术后6个月甲状腺结节体积缩小率(68.35±3.17)%,明显大于术后1个月(17.18±1.24)%(q=159.162,P<0.05)。甲状腺结节的最大直径术后6个月(0.62±0.19)cm,明显小于术前(2.16±0.45)cm(q=35.038,P<0.05)。术后1、3、6个月FT3、FT4、TSH均在正常范围。37例随访(7.4±1.3)月(6~10个月),13枚结节完全消失。结论超声引导下MWA治疗甲状腺良性结节疗效好,微创优势明显。

Objective To explore the clinicial efficacy of ultrasound-guided microwave ablation（ MWA） for the treatment of benign thyroid nodules. Methods From October 2014 to February 2015,thirty-seven patients with benign thyroid nodules underwent ultrasound-guided MWA. We made a 1 mm incision at the neck,cut the skin and subcutaneous tissues,and then inserted a microwave needle into the center point of the nodules for MWA. The nodules were treated with ＂ moving-unit ablation＂（ MUA）. All the patients were subjected to the measuring of preoperative and postoperative first,third,sixth months values of nodule volume,volume-reduction ratio,largest diameter,thyroid function status and complication rates. Results Thirty-seven patients and a total of59 nodules underwent ultrasound-guided MWA smoothly. There was no conversion to open surgery. A total of 19 patients described a swelling pain of cervical region,which disappeared at next day. Three patients described a spreading of pain towards the root of ears,which disappeared at postoperative 2- 3 days. Two patients experienced recurrent laryngeal nerve injury,and their voice recovered within 4 postoperative months. No burns of skin,infections,or hemorrhage happened. The thyroid nodule volume was significantly smaller at postoperative 6 month（ 0. 86 ± 0. 25） cm3 than before ablation（ 3. 49 ± 0. 27） cm3（ q = 60. 269,P〈0. 05）. The volumereduction ratio was higher at postoperative 6 month（ 68. 35 ± 3. 17） % than before ablation（ 17. 18 ± 1. 24） %（ q = 159. 162,P〈0. 05）. The largest thyroid nodule diameter was smaller at postoperative 6 month（ 0. 62 ± 0. 19） cm than before ablation（ 2. 16 ±0. 45） cm（ q = 35. 038,P〈0. 05）. The thyroid function status was normal at postoperative 1 month,3 month,and 6 month. The follow-up duration was（ 7. 4 ± 1. 3） months（ range,6- 10 months）. A total of 13 benign thyroid nodules completely disappeared at postoperative follow-up duration. Conclusion MWA is a safe,effective,and minimally invasive method for the treatment of benign thyroid nodules.