改良超声引导经皮注射无水乙醇治疗囊性甲状腺腺瘤

Modified ultrasound-guided percutaneous ethanol injection for treating cystic thyroid adenomas

目的 :评价超声引导下经皮注射无水乙醇 (PEI)治疗囊性甲状腺腺瘤的技术改良、疗效、安全性及不良作用。 方法 :高频超声引导下 PEI治疗 5 7例单侧、单发性囊性甲状腺腺瘤。男 34例 ,女 2 3例 ,年龄 2 9～ 6 2岁 ,中位年龄 4 7岁。甲状腺腺瘤平均最大直径 (37.5 5± 5 .6 4 ) mm (17～ 5 9m m )。囊性腺瘤内含部分实性组织者 12例 ,病灶完全囊性者 4 5例。 结果 :经过3～ 30个月 (平均 2 5 .5个月 )的随访 ,38例 (6 6 .7% )疗效显著 ,腺瘤均为完全囊性 ;11例 (19.3% )有效 ;5例 (9.8% )需要第 2次穿刺治疗 ,均为实性组织相对较多者 ;5 .3%转行外科手术 ,囊液呈胶冻样。 2 1例术中出现局部短暂性疼痛 ,15例治疗 4 8h内发热 ,3例出现短暂性声音嘶哑。没有严重出血病例。 T3、T4 、TSH无明显变化。 结论 :超声引导下 PEI是囊性甲状腺腺瘤有效、安全、简单的治疗方法。治疗前根据超声图像选择合适病例可以减少操作失败 ;

Objective: To assess the technique, efficacy, security and side effects of percutaneous ethanol injection(PEI) in treating the cystic thyroid adenomas. Methods: Fifty seven patients(male 34, female 23) with unilateral and solitary benign cystic thyroid adenoma received PEI therapy under high resolution ultrasound guidance. The medial age of the patients was 47 years(ranging 29 62). The mean diameter in the largest section of the thyroid adenomas was (37.55±5.64) mm(17 59 mm). The thyroid lesions in 12 patients consisted of cystic lumen mixed with solid structure, and the rest 45 had entire cystic thyroid lesions. Ultrasound reexamination of thyroid lesions was done 3 months after the initial treatment. Significant curative effect was defined as an adenoma volume shrinkage rate larger than 50%. The efficacious result was defined as a volume shrinkage rate between 40% and 50% together with a further shrink over a 6 month duration follow up. Those patients with adenoma volume shrinkage rate less than 40% underwent a second PEI after 6 months. Results: Over a mean duration of 25.5 months follow up, 66.7% subjects with entirely cystic had significant curative outcome; 19.3% subjects had efficacious result; and 9.8% subjects needed a second PEI and their thyroid lesions contained more solid tissue. There were 5.3% subjects were transfered to open surgery due to colloid cyst fluid. Twenty one patients complained of intraoperative local transient pain; 15 patients had transient pyrexia in the 48 h after injection, and 3 patients were affected by post operative transient dysphonia. No serious bleeding were encountered, and no apparent change of serum T 3,T 4,TSH level was observed. Conclusion: Ultrasound guided PEI therapy is an effective, safe and simple procedure for the ablation of cystic thyroid adenoma. Careful selection of subjects according to their preoperative thyroid ultrasonographies can reduce the unsuccessful PEI. A selective volume of ethanol injection consistent with the adenoma size on sonograms and a thorough flush with ethanol can improve the efficacy of PEI.