激光消融治疗48例甲状腺良性结节临床分析

Laser ablation on thyroid benign nodules: a clinical analysis of 48 cases

目的探讨甲状腺良性结节激光消融治疗的安全性、方法和近期疗效。方法回顾性分析我科2014年9月至2015年5月48例甲状腺良性结节激光消融治疗患者的临床资料。观察治疗时间、消融针数、输出能量、甲状腺功能变化、术中及术后并发症和随访结果。结果 48例甲状腺良性结节患者均成功实施激光消融,每个结节消融1～4（1.5±1.2）针,治疗时间15～40（23.3±15.8）min,激光输出总能量800～7 200（2 225±1 875）J,无神经、气管、食管、血管损伤或皮肤灼伤等并发症。术后1、3个月超声随访,甲状腺结节体积较术前显著缩小（P〈0.05）,血流信号消失。术中48例患者均有颈部轻微疼痛,术后46例患者疼痛自行缓解,2例患者予对症处理后疼痛减轻。术前、术后1、3个月检测甲状腺功能无显著变化（P〉0.05）。结论激光消融治疗甲状腺良性结节安全、微创、有效,对甲状腺功能无影响,具有较好的临床推广应用价值。

Objective To investigate the safety,procedure and short-term efficacy of ultrasoundguided laser ablation（ LA） for benign thyroid nodule. Methods The clinical data of 48 patients with benign thyroid nodules receiving ultrasound-guided LA from September 2014 to May 2015 in our hospital were collected and analyzed retrospectively. The treatment time,number of ablation procedure,total output energy,thyroid function,and intra- and post-operative complications and follow-up results were observed. Results All the 48 patients underwent the ultrasound-guided LA treatment successfully. The mean number of ablation needles was 1. 5 ± 1. 2（ 1 to 4）,the mean operation time was 23. 3 ± 15. 8（ 15 to 40） min,and the total laser output energy was 2 225 ± 1 875（ 800 to 7 200） J. No nervous,tracheal,esophageal and blood vessel damages,skin burns and other complications occurred. Ultrasound examination in 1 and 3 months after operation indicated that thyroid nodule volume was significantly reduced compared with preoperative size（ P〈0. 05）,and the blood flow signal in the nodules disappeared. During the operation,all patients have local slight tolerable pain,but 46 of them were relieved without any processing,and the other 2 complained of the continuous pain,which was ameliorated or totally relieved after appropriate treatment. The thyroid function had no significant changes before and in 1 and 3 months after treatment（ P〈0. 05）. Conclusion Ultrasound-guided LA is a safe,effective and mini-invasive treatment for benign thyroid nodules,and without adverse effect on thyroid function. It is worthy of promotion in clinical practice.