微波消融治疗168例甲状腺良性结节的临床体会

Clinical experience of microwave ablation in the treatment of 168 benign thyroid nodules

目的随着临床影像检查技术的快速发展,甲状腺结节的检出率逐年增高,尤其是高频超声的应用,使甲状腺结节的检出率由4%~7%提高至17%~67%。本研究通过微波消融治疗甲状腺良性结节的临床研究,分析了微波消融在治疗甲状腺良性结节中的操作技巧、安全性和治疗效果。方法选取淄博市张店区妇幼保健院2016-05-18-2018-05-21收治的168例(278个结节)甲状腺良性结节行微波消融治疗患者,术前全部经细针穿刺细胞学检查确诊为良性结节,术前、术后行造影检查和(或)超声检查,观察结节血流信号、结节大小和有无并发症等情况,于术后1、3、6、9和12个月分别进行疗效评价。结果微波消融治疗甲状腺良性结节,结节清除率100%,术后12个月消融灶体积减小率(volumereduction ratio,VRR)85.64%。无术后立即出现声音嘶哑病例,12例患者术后第2天出现声音嘶哑,占7.14%,考虑与热辐射和水肿有关,1~3个月全部恢复。术前和术后血清甲状腺激素水平无明显变化;部分患者出现甲状腺自身抗体升高,但随访6个月后均显示无异常。术后6个月168例患者均对颈部外观及消融进针口情况满意,满意度达100%。结论微波消融在治疗甲状腺良性结节具有操作简单、安全性高、美容效果好、疗效确切等优点,具有一定的临床应用价值。

OBJECTIVE To evaluate the operation skill,safety and therapeutic effect of microwave ablation in the treatment of benign thyroid nodules.METHODS From May 2016 to may 2018,168 cases(278 nodules)of benign thyroid nodules were treated by microwave ablation.All of them were confirmed as benign nodules by cytological examination before operation.Before and after operation,they were examined by contrast and/or ultrasound.The blood flow signal,nodule size and complications were observed.The therapeutic effects were carried out 1,3,6,9 and 12 months after operation evaluate.RESULTS Treatment of benign nodules in the thyroid gland with microwave ablation,the node clearance rate was 100%,and the volumereduction rate(VRR)of the ablation oven was 85.64%.Hoarseness occurred immediately after surgery in 12 patients,accounting for 7.14%,considered with heat radiation and water swelling related,1-3 months full recovery.There were no obvious changes of serum thyroxin hydronephrosis before and after operation.In some patients,the body resistance of the thyroid gland was increased,but no abnormality was observed after 6 months of followup.After 6 months of operation,168 patients were satisfied with the external view of the neck and the situation of melting into the needle mouth,the degree of satisfaction was up to 100%.CONCLUSION Microwave ablation in the treatment of benign thyroid nodule has the advantages of simple operation,high safety,good cosmetic effect,exact curative effect and wide clinical application prospect.