超声引导甲状腺良性结节激光消融术后中期疗效评价

Evaluation and analysis of the mid-term efficacy of ultrasound-guided laser ablation of benign thyroid nodules

目的探讨超声引导下甲状腺良性结节激光消融术后中期的临床疗效。方法在超声引导下经皮激光消融治疗38例患者共38枚甲状腺良性结节,定期随访30个月以上,观察消融并发症、结节体积缩小率,对残余结节行穿刺活检以观察其病理改变。结果38枚结节激光消融术后未并发声嘶、呛咳、抽搐、血肿等,复查甲状腺功能均正常;术后6、12、24个月、30个月复查彩超示结节体积缩小率分别为67.2%、80.4%、85.5%、90.6%,与消融前体积比较,差异有统计学意义(P<0.05);所有结节体积缩小率>50%,有8枚结节吸收消失,显效率100%,治愈率21.1%;结节体积缩小趋势图显示呈缩小趋势,术后6个月内缩小幅度最大;残余结节穿刺病检未见甲状腺滤泡细胞,病理性完全消融率100%。结论超声引导下激光消融治疗甲状腺良性结节安全有效,消融后残余结节的病理性完全消融率、复发率、再消融率、再手术率,可作为评估中期疗效的重要指标。

Objective To evaluate and analyze the efficacy of ultrasound guided laser ablation of benign thyroid nodules in the middle term.Methods 38 benign thyroid nodules were treated by ultrasound-guided percutaneous laser ablation in 38 patients.Patients were followed up regularly for more than 30 months to observe the ablation complications and the reduction rate of nodules volume.Results No hoarseness,coughing,convulsion and hematoma were found in 38 nodules after laser ablation.The rates of nodule volume reduction were 67.2%,80.4%,85.5%and 90.6%,respectively,when compared with the volume before ablation.The volume reduction rate of all nodules was>50%,the absorption of 8 nodules disappeared,the obvious efficiency was 100%,and the cure rate was 21.1%.The trend of nodule volume reduction showed a trend of decrease,with the greatest reduction within 6 months after surgery.No thyroid follicular cells were detected by residual nodule puncture,and the pathologic complete ablation rate was 100%.Conclusion Ultrasound-guided laser ablation for benign thyroid nodules is safe and effective,and the pathological complete ablation rate,recurrence rate,reablation rate and reoperation rate of residual nodules after ablation can be an important indicator to evaluate the mid-term efficacy.