经皮微波消融治疗自主功能性甲状腺结节的临床研究  

Clinical study of preutaneous microwave ablation in the treatment of autonomous functional thyroid nodules

作　　者：陈吉东[1] 岳林先[1] 尹立雪[1] 陈琴[1] 熊晏群[2] 冯超[3] 顾毅[3] 黄际远[4] 朱鸿[5] 张磊[6] Chen Jidong;Yue Linxian;Yin Lixue;Chen Qin;Xiong Yanqun;Feng Chao;Cru Yi;Huang Jiyuan;Zhu Hong;Zhang Lei(Ultrasonic Medical Center,Academy of Medial Sciences & Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院超声医学中心,成都610072 [2]四川省医学科学院·四川省人民医院手术室,成都610072 [3]四川省医学科学院·四川省人民医院甲状腺外科,成都610072 [4]四川省医学科学院·四川省人民医院核医学科,成都610072 [5]四川省医学科学院·四川省人民医院病理科,成都610072 [6]四川省医学科学院·四川省人民医院内分泌科,成都610072

出　　处：《中华超声影像学杂志》2018年第11期958-962,共5页Chinese Journal of Ultrasonography

摘　　要：目的研究微波消融(microwave ablation,MWA)治疗自主功能性甲状腺结节(autonomous functional thyroid nodules,AFTN)的临床疗效及安全性。方法收集拒绝或不适合外科切除手术和131I治疗的AFTN患者53例共67个结节纳入研究。所有结节均行常规超声、彩色多普勒血流显像(color Doppler flow imaging,CDFI)及超声造影评估均为良性声像特征,并经病理证实,再行经皮MWA。采取液体隔离及移动消融等技术,并用超声造影实时监测及疗效评估。观察项目:甲状腺激素水平、结节体积、结节血供、核素显像、自觉症状及美容评分、并发症,最后分析影响MWA疗效的因素。结果所有病例随访>12个月。甲状腺激素水平、结节体积、结节血供与治疗前比较差异均具有统计学意义(P<0.01)。61个“热结节”变为“冷或温结节”。自觉症状和美容评分改善率的差异具有统计学意义(P<0.05)。本研究中痊愈率81.13%,并发症发生率为11.32%,复发率为4.48%。治疗前结节体积≥14.04ml和危险部位为影响疗效的主要因素。结论MWA能原位灭活AFTN,使其分泌功能丧失并逐步缩小。常规超声和超声造影引导下经皮MWA治疗AFTN可视为除外科切除手术和131I治疗以外的另一种安全有效治疗方式。Objective To study the clinical efficacy and safety of microwave ablation (MWA)in the treatment of autonomous functional thyroid nodules(AFTN).Methods Sixty-seven nodules of 53 AFTN patients who refused or were not suitable for surgical resection and 131 I therapy were enrolled in the study. All the nodules were evaluated by ultrasound,color Doppler flow imaging(CDFI)and contrast enhanced ultrasound(CEUS),and all of them were benign and confirmed by pathology.And then,percutaneous MWA was performed.Fluid isolation and mobile ablation were used to completely inactivate the nodules,and CEUS was used to evaluate the efficacy of the treatment.The following items included thyroid hormone level,nodule volume,nodular blood supply,thyroid radionuclide imaging,conscious symptom,beauty score and complication.Finally,the factors influencing the curative effect were analyzed.Results The follow-up period was at least 12 months.Compared with before treatment,the differences of thyroid hormone level, the volume of nodules,the nodule blood supply were statistically significant (P<0.01).The 61"hot nodules"changed to "cold or warm nodules".The differences between the improvement ratio of conscious symptoms and beauty scores were statistically significant(P<0.05).The cure ratio in this study was 81.13%,and the incidence of complications was 11.32%,and the recurrence ratio was 4.48%.The nodule volume≥14.04 ml or in a dangerous position were the main factors affecting the curative effect.Conclusions MWA can inactivate the AFTN in situ,make it lose the secretory function and reduce the volume of nodules.Therefore,percutaneous MWA guided by ultrasound and CEUS treatment of AFTN can be regarded as another safe and effective treatment besides surgical resection or 131I therapy.

关 键 词：超声造影 微波消融术 甲状腺结节 临床疗效 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]