超声引导下微波消融治疗甲状腺峡部乳头状癌

Ultrasound-guided microwave ablation for papillary carcinoma of thyroid isthmus

目的观察超声引导下微波消融(MWA)治疗甲状腺峡部乳头状癌(PTC)的安全性及可行性。方法纳入92例符合超声引导下MWA治疗指征的甲状腺峡部PTC患者,比较治疗前与治疗后1、3、6个月三碘甲状腺原氨酸(T 3)、游离甲状腺素(FT 4)和促甲状腺激素(TSH)、血钙和全段甲状旁腺激素(iPTH)水平;观察治疗前与治疗后18个月内病灶最大径和体积变化。结果对92例均顺利完成MWA,平均消融时间(105.6±24.8)s。治疗后随访10~60个月,中位时间35个月,期间所有患者均存活。治疗后1、3及6个月,T 3、FT 4、TSH、血钙及iPTH水平与治疗前差异均无统计学意义(P均>0.05)。治疗后1、3个月病灶最大径及体积均较治疗前明显增加(P均<0.05),6~18个月病灶最大径和体积较治疗前明显缩小(P均<0.05)。未见甲状腺功能低下、甲状旁腺功能损伤、喉返神经损伤、气管和食管损伤等严重并发症。结论超声引导下MWA治疗峡部PTC安全、可行。

Objective To observe the feasibility and safety of ultrasound-guided microwave ablation(MWA)for treatment of isthmus papillary thyroid carcinoma(PTC).Methods A total of 92 patients with isthmus PTC who met the indications of ultrasound-guided MWA treatment were enrolled.The levels of triiodothyronine(T 3),free thyroxine(FT 4)and thyrotropin(TSH),serum calcium and intact parathyroid hormone(iPTH)were compared before treatment and 1,3 and 6 months after treatment.The changes of the maximum diameter and volume of lesions were compared before and within 18 months after treatment.Results MWA was successfully completed in all 92 cases,and the mean ablation time was(105.6±24.8)s.The following-up time was 10—60 months after treatment,with a median time of 35 months,and all patients survived.There was no significant differences of the levels of T 3,FT 4,TSH,serum calcium and iPTH at 1,3 and 6 months after treatment compared with those before treatment(all P>0.05).The maximum diameter and volume of lesions significantly increased at 1 and 3 months after treatment,and then significantly decreased at 6 to 18 months after treatment compared with those before treatment(all P<0.05).No serious complication such as hypothyroidism,parathyroid function injury,recurrent laryngeal nerve injury,trachea nor esophagus injury occurred.Conclusion Ultrasound-guided MWA was safe and feasible for treating thyroid isthmus PTC.