预防甲状腺良性结节微波消融热损伤并发症的有效方法:“杠杆撬离法”

"Leverage pry-off method"for effective prevention of thermal injury during microwave ablation of benign thyroid nodules

目的探讨“杠杆撬离法”预防甲状腺良性结节微波消融过程中热损伤并发症的安全性、有效性。方法348例甲状腺良性结节行超声引导下微波消融治疗,其中174例采用“液体隔离带法”预防热损伤,即“液体隔离带”组;另174例采用“杠杆撬离法”预防热损伤,即“杠杆撬离法”组,术后随访1~12月,观察严重并发症的发率及结节残留发生率。结果348例甲状腺良性结节均在超声引导下完成微波消融治疗,手术严重并发症均为声音改变,其中“液体隔离带”组3例,发生率为1.7%“;杠杆撬离法”组4例,发生率为2.3%,两组严重并发症的发生率比较差异无统计学意义(P>0.05)。术后随访1~12月“,液体隔离带”组17例结节边缘有少量残留组织,残留发生率为9.8%“;杠杆撬离法”组19例结节边缘有少量残留组织,残留发生率为10.9%,两组间结节残留发生率比较差异无统计学意义(P>0.05)。结论“杠杆撬离法”是预防甲状腺良性结节微波消融过程热损伤并发症的简便有效方法。

Objective To assess the safety and efficacy of"leverage pry-off method"for preventing thermal injury during microwave ablation of benign thyroid nodules.Methods From July,2017 to September,2019,a total of 348 patients with benign thyroid nodules underwent ultrasound-guided microwave ablation.For protecting from thermal injury during the ablation,"hydrodissection technique"was used in 174 of the patients(admitted from July,2017 to August,2018)and"leverage pry-off method"in the other 174 patients(admitted from September,2018 to September,2019).All the patients were followed up for 1to 12 months after the operation for observation of severe complications and nodular residues.Results Ultrasound-guided microwave ablation was completed in all the 348 patients.The most common severe complication associated with the ablation was voice change,occurring in 3 cases(1.7%)in"hydrodissection technique"group and in 4(2.3%)in the"leverage pry-off method"group,showing no significant difference between the two groups(P>0.05).During the follow-up,no significant difference was found in the rate of nodular residues between the"hydrodissection technique"group and"hydrodissection technique"group(9.8%)vs 10.9%(P>0.05).Conclusions The"leverage pry-off method"is simple and effective for preventing thermal injury during microwave ablation of benign thyroid nodules.