超声引导下经皮微波消融治疗甲状腺乳头状微小癌的初步探讨  

Primary approach for ultrasound-guided percutaneous microwave ablation of papillary thyroid microcarcinoma

作　　者：于守君[1] 岳雯雯[1] 张永林[1] 陈良[1] 王淑荣[1] 

机构地区：[1]滨州医学院烟台附属医院超声科,264100

出　　处：《中华超声影像学杂志》2015年第9期779-783,共5页Chinese Journal of Ultrasonography

基　　金：山东省科技发展计划（2011YD18028）;烟台市科技攻关计划（2010156）

摘　　要：目的评估超声引导下经皮微波消融结合激素抑制治疗单发甲状腺乳头状微小癌的有效性及可行性。方法采用冷循环微波针对25例经病理证实的25个单发甲状腺乳头状微小癌病灶进行超声引导下微波消融治疗。病灶直径范围3．7～10．0mm，且无淋巴结及远处转移。微波消融功率设为40w，微波消融时间最初设为200～400s，为使结节达到彻底坏死消融时间可根据需要延长。所有病灶均采用扩大消融术，消融术后服用左旋甲状腺激素将促甲状腺激素水平控制在0．1mU／L以下。消融前对患者的甲状腺功能、结节容积及临床症状进行评估，并在术后第1，3，6，9，12个月进行随访，监测甲状腺结节容积变化、甲状腺功能的变化、不良反应、并发症及有无转移。术后25例患者有3例转外科手术切除，余22例在随访中均进行了常规超声及超声造影检查。结果25枚结节均通过多切面固定消融法达到完全灭活，手术过程顺利，患者耐受性良好，无严重或永久性并发症发生。在平均18个月的随访中，所有患者均未出现复发和转移。其中3例转行外科手术者切除病灶病理结果显示均未见明显肿瘤细胞。结论超声引导下经皮微波消融治疗单发甲状腺乳头状微小癌安全可行，效果可靠，具有一定的临床应用价值。Objective To evaluate the feasibility and efficacy of ultrasound-guided percutaneous microwave ablation combined with hormone suppression therapy for solitary papillary thyroid microcarcinoma. Methods A total of 25 patients with 25 nodules pathologically proven solitary papillary carcinoma 3.7 to 10.0 mm in diameter without clinically apparent lymph node,or distant metastasis were treated with microwave ablation equipement. Microwaves were emitted at 40 W for 200 - 400 seconds and prolonged as necessary to attain confluent ablation zones. All patients were treated with both extended ablation therapy and levothyroxine that maintain TSH levels below 0.1 mU/L. Thyroid function test, nodule volume and clinical symptom were evaluated before ablation and during 1,3,6,9 and 12 months after treatment according to changes in tumor size, adverse reactions, complications and metastatic tumors. Three out of 25 patients received surgical treatment and the other 22 patients were followed up with routine ultrasound and contrast enhanced ultrasound. Results All 25 tumors were completely ablated by using mutiple plane fixed melting method and no serious or permanent complications occurred. No recurrence at the treatment site or distant metastase were detected, with a mean follow-up of 18 months. Histological examination showed no evidence of a tumor in the treated lesions in the 3 surgery patients. Conclusions Ultrasound-guided percutaneous microwave ablation appears to be a safe and effective technique for the therapy of solitary papillary thyroid microcarcinoma.

关 键 词：超声检查 甲状腺肿瘤 微波/治疗应用 

分 类 号：R736.1[医药卫生—肿瘤]