超声引导下微波消融治疗儿童甲状腺结节的临床疗效分析  

Clinical outcomes of microwave ablation under ultrasonic guidance for benign thyroid nodules in children

作　　者：胡彩辉 陈镜宇[1] 郑陈鹏 唐毅[1] 赵珍珍[3] 孔祥如[3] Hu Caihui;Chen Jingyu;Zheng Chenpeng;Tang Yi;Zhao Zhenzhen;Kong Xiangru(Department of Ultrasonography,Affiliated Children's Hospital,Chongqing Medical University,National Clinical Research Center for Children's Health&Disorders,Ministry of Education's Key Laboratory of Children's Development&Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China;Department of Ultrasonography,Municipal Emergency Medical Center,Chongqing 400016,China;Department of Surgical Oncology,Affiliated Children's Hospital,Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院超声科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆400014 [2]重庆市急救医疗中心超声科,重庆400016 [3]重庆医科大学附属儿童医院肿瘤外科,重庆400014

出　　处：《临床小儿外科杂志》2024年第3期262-266,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的初步探讨超声引导下经皮穿刺微波消融治疗儿童甲状腺良性结节的安全性、临床疗效。方法回顾性分析2022年1月至2022年12月在重庆医科大学附属儿童医院接受超声引导下微波消融治疗的9例甲状腺良性结节患儿临床资料。观察指标包括手术情况(切口大小、总手术时长、消融时长、术中出血量及是否输血等)、疼痛评分、甲状腺功能及超声相关指标。医师根据FACES(Wong-Baker pain rating scale)脸谱疼痛法评估患儿一般情况,术后采用超声造影评估消融率,常规超声随访结节体积变化以评估疗效,并记录术中、术后的不良反应及并发症。结果9例患儿(共14个结节)总手术时长为(45.11±4.85)min(23~65 min),消融时长为(188.89±50.37)s(40~500 s),术中出血量为(0.3±0.03)mL(0.1~0.4 mL)。患儿术后12 h FACES评分为2~4分,术后24 h FACES评分为0~2分。术后即刻超声造影结果显示,14个结节消融率均为100%。术前结节体积为0.73(0.14,3.62)cm^(3),术后1个月结节体积为0.54(0.19,1.49)cm^(3),术后4个月结节体积为0.03(0.02,0.25)cm^(3);术后4个月结节体积较术前显著减小(H=12.714,P=0.018),较术后1个月显著减小(H=12.036,P=0.028)。术前血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)为(6.44±1.42)Pmol/L(4.43~8.2 Pmol/L),术后12 h为(12.8±3.37)Pmol/L(8.36~18.5 Pmol/L),术后1个月为(7.54±1.56)Pmol/L(5.36~9.53 Pmol/L);术后12 h较术前显著增高,差异有统计学意义(F=19.636,P<0.001)。不同时点的血清游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyrotropin,thyroid stimulating hormone,TSH)差异均无统计学意义(P>0.05)。术中无一例出血过多等不良反应,术后无一例声音嘶哑、抽搐、饮水呛咳等并发症。结论超声引导下微波消融术可能是治疗儿童甲状腺良性结节的一种新选择,具有微创、安全性高、临床疗效好、对甲状腺功能损伤小、疼痛感弱等优势;然而本研究样本量相�Objective To explore the safety,clinical efficacies and outcomes of ultrasound-guided percutaneous microwave ablation for children with benign thyroid nodules.Methods A retrospective analysis was conducted for the clinical data of 9 children with benign thyroid nodules undergoing ultrasound-guided percutaneous microwave ablation from January 2022 to December 2022.The relevant parameters included general surgical profiles(incision size,total operative duration,ablation duration,intraoperative volume of blood loss&necessity for blood transfusion),pain scores,thyroid function and ultrasound-related parameters.Results In 9/14 nodules,overall operative duration was(45.11±4.85)(23-65)min,ablation time(188.89±50.37)(40-500)sec and intraoperative volume of hemorrhage(0.3±0.03)(0.1-0.4)mL.The postoperative Wong-Baker pain rating scale(FACES)scores were(2-4)/(0-2)points at 12/24 h.Immediate postoperative contrast-enhanced ultrasonography confirmed the ablation rate of all 14 nodules was 100%.The median nodule volume was 0.73(0.14,3.62)cm^(3)before operation,0.54(0.15,1.49)cm^(3)at 1 month after opeation,0.03(0.02,0.25)cm^(3)at 4 months after operation,The nodule volume at 4 months after operation was significantly smaller than that before operation(H=12.174,P=0.018)and 1 month after operation(H=12.036,P=0.028)The serum FT3 was(6.44±1.42)(4.43-8.2)Pmol/L pre-operation,(12.8±3.37)(8.36-18.5)Pmol/L at 12 h post-operation,(7.54±1.56)(5.36-9.53)Pmol/L at Month 1 post-operation.Serum FT3 was significantly higher at 12 h post-operation than pre-operation(F=19.636,P<0.001).No statistically significant differences existed in serum levels of FT4 and TSH at various timepoints(P>0.05).Neither adverse reactions nor postoperative complications occurred.Conclusions Ultrasound-guided percutaneous microwave ablation is ideal benign thyroid nodules in children.It offers such advantages as mini-invasiveness,high safety,satisfactory outcomes,minimal damage to thyroid function and minimal pains.However,the study's limited sample size nec

关 键 词：甲状腺良性结节 微波消融 甲状腺激素 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]