超声引导下Ⅰ型胸骨后甲状腺肿微波消融治疗的可行性及临床疗效

Feasibility and clinical efficacy of ultrasound-guided MWA in treating typeⅠsubsternal goiter

目的探讨超声引导下微波消融技术(MWA)治疗Ⅰ型胸骨后甲状腺肿的可行性及临床疗效。方法选取2014年1月至2015年12月经病理学证实为Ⅰ型胸骨后甲状腺肿患者68例行超声引导MWA治疗。观察患者术前及术后1、3、6个月甲状腺功能、结节消融区体积及体积缩小率变化,记录患者术后并发症发生率。结果 68例患者(75枚结节)均顺利完成超声下MWA治疗,患者术后均无出现永久性声音嘶哑,所有病灶均达到完全灭活。在术后半年随访中,患者无复发。患者术后1、3、6个月甲状结节肿缩小率显著大于术前,差异有统计学意义(P<0.05),而甲状腺结节体积、甲状腺结节最大直径术后6个月显著小于术前,差异有统计学意义(P<0.05)。患者术后1、3、6个月血清游离三碘甲腺原氨酸(FT3)、游离四碘甲腺原氨酸(FT4)及促甲状腺激素(TSH)水平与术前比较差异无统计学意义(P>0.05)。结论超声引导下MWA治疗Ⅰ型胸骨后甲状腺肿效果显著,患者术后无显著并发症,安全可靠,建议临床推广应用。

Objective To investigate the feasibility and clinical efficacy of ultrasound-guided microwave ablation（MWA）for treating typeⅠsubsternal goiter.Methods Sixty-eight patients with typeⅠsubsternal goiter verified by pathology underwent the ultrasound-guided MWA from January 2014 to December 2015.The changes of thyroid function,thyroid nodules ablation zone size and volume reduction rate before operation and at postoperative 1,3,6months were observed and the postoperative complication occurrence situation was recorded.Results Sixty-eight cases（75nodules）were successfully completed ultrasound-guided MWA treatment,no postoperative permanent hoarseness appeared in all cases,and all lesions reached complete inactivation.The patients had no recurrence during postoperative 6-months follow-up.The swollen thyroid nodules reduction rate at postoperative 1,3,6months was significantly greater than before operation,the difference was statistically significant（P〈0.05）,while the volume of thyroid nodules,maximum diameter of thyroid nodules at postoperative 6months were significantly less than before operation（P〈0.05）.The levels of free triiodothyronine（FT3）,free four iodine thyronine（FT4）and thyroid stimulating hormone（TSH）at postoperative 1,3,6months had no statistically significant difference compared with before operation（P〉0.05）.Conclusion Ultrasound-guided MWA for treating typeⅠ substernal goiter has significant effect without obvious postoperative complications,is safe and reliable,it is recommended to promote and apply in clinic.