改良隔离法在高风险甲状腺结节消融术中的应用

Application of improved isolation method in thyroid nodule ablation with high risk

目的:探讨改良隔离法在高风险甲状腺结节消融时对周围组织保护的应用价值。方法:选取医院收治的656例行微波消融的甲状腺良性病变结节患者,消融时向甲状腺病灶所在腺体及周围结构建立隔离带,按隔离方法的不同将其分为传统隔离组(310例)和改良隔离组(346例),比较两种隔离方法在术中的应用效果。结果:传统隔离组和改良隔离组术中隔离液的注入量分别为(33.17±9.31)ml和(47.77±14.14)ml,差异有统计学意义(t=-4.722,P<0.05);传统隔离组和改良隔离组消融时间分别为(108.52±73.72)s和(106.07±78.44)s,差异无统计学意义(t=0.291,P>0.05);传统隔离组与改良隔离组并发症发生情况中,喉返神经永久损伤分别为2例及0例,短暂性声音嘶哑(3月内恢复)分别为15例及2例,差异有统计学意义(χ^(2)=16.254,P<0.05);传统隔离组与改良隔离组术区疼痛感分别为158例和132例,差异有统计学意义(χ^(2)=10.482,P<0.05);传统隔离组与改良隔离组视觉疼痛评分分别为(3.78±0.70)分和(3.29±0.75)分,差异有统计学意义(t=-2.100,P<0.05);传统隔离组与改良隔离组颈部肿胀感分别为42例和108例,差异有统计学意义(χ^(2)=64.149,P<0.05);传统隔离组与改良隔离组二次消融率分别为4.84%和0.58%,差异有统计学意义(χ^(2)=10.131,P<0.05)。结论:改良隔离法在高风险甲状腺结节消融术中有效的减少了并发症的发生,保证了手术的成功实施。

Objective:To evaluate the application value of improved isolation method in protecting surrounding tissues during thyroid nodule ablation with high-risk.Methods:A total of 656 patients with benign thyroid lesions who underwent microwave ablation in hospital were selected.An isolation band was established in the gland with the thyroid lesions and the surrounding structure during the ablation.And they were divided into conventional isolation group(310 cases)and improved isolation group(346 cases)according to difference of isolation method.The application effects of two methods in the surgery were further compared.Results:The injection volume of isolation fluid in conventional isolation group and improved isolation group were(33.17±9.31)ml and(47.77±14.14)ml,respectively,and the difference of that between the two groups was statistically significant(t=-4.722,P<0.05).And the ablation times of conventional isolation group and improved isolation group were(108.52±73.72)s and(106.07±78.44)s,respectively,and the difference of that between two groups was not statistically significant(t=0.291,P>0.05).In the complications of the two groups,the cases of permanent injury of recurrent laryngeal nerve respectively were 2 cases and 0 case in conventional isolation group and improved isolation group,and the cases of transient hoarseness(recovery within 3 months)were 15 cases and 2 cases in the two groups,respectively,and the difference of that between two groups was significant(χ^(2)=16.254,P<0.05).158 cases and 132 cases respectively occurred pain sensation in surgery region in the two groups,and the difference of that between two groups was statistically significant(χ^(2)=10.482,P<0.05).The scores of vision pain of the two groups were(3.78±0.70)and(3.29±0.75),respectively,and the difference of that between them was statistically significant(t=-2.100,P<0.05).The sensation of neck swelling occurred in 42 cases of conventional isolation group and 108 cases of improved isolation group,and the difference of that between two groups was statistically significant(χ^(2)=64.149,P<0.05).Secondary ablation rates of the two groups were 4.84%and 0.58%,respectively,and the difference of that between two groups was statistically significant(χ^(2)=10.131,P<0.05).Conclusion:The improved isolation method can effectively reduce the occurrences of complications during thyroid nodule ablation with high-risk and ensure the successful implementation of the surgery.