超声引导下经皮微波消融治疗Ⅰ型胸骨后甲状腺肿  

Percutaneous microwave ablation of type Ⅰ substernal goiter under ultrasonic guidance

作　　者：徐庆玲[1] 陈云乾 隋亚平[1] 王军[1] 王淑荣[1] 

机构地区：[1]滨州医学院烟台附属医院超声科,烟台264100

出　　处：《中华超声影像学杂志》2016年第1期48-52,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：目的探讨超声引导下Ⅰ型胸骨后甲状腺肿微波消融治疗的可行性及临床疗效。方法收集接受超声引导下经皮微波消融治疗的13例Ⅰ型胸骨后甲状腺肿患者的临床资料，对13例患者47枚结节行超声引导下微波消融治疗，术中利用“热阻断血流”方法，预防患者出现严重出血；利用“液体隔离带”和“杠杆撬离”方法有效保护甲状腺周围重要结构免受热损伤；利用“少量残留法”避免气管痉挛或塌陷。术后第1、3、6、12个月进行随访，监测甲状腺结节容积变化、不良反应及并发症。结果13例患者47枚结节均顺利行超声引导下经皮微波消融治疗，其中2例患者因结节过大，气管明显移位，且年龄较大、身体耐受较差行二次治疗，术毕超声造影及彩色多普勒显示消融区病灶均达到完全灭活。13例患者均无明显并发症发生、无永久性声音嘶哑。所有患者术后1～4个月颈部压迫症状及不适感消失，消融术后12个月有效随访Ⅰ型胸骨后甲状腺肿患者13例，其甲状腺功能均在正常范围，甲状腺结节容积缩减率为（85±31）％。结论超声引导下经皮微波消融治疗Ⅰ型胸骨后甲状腺肿无严重并发症，是一种安全有效的治疗方法，值得在临床推广。Objective To investigate the feasibility and clinical effect for pereutaneous microwave ablation of type I substernal goiter under the guidance of ultrasound. Methods Thirteen patients with type I substernal goiter were selected. All patients underwent percutaneous microwave ablation treatment under the guidance of ultrasound. Thirteen patients with 47 medals nodules were performed ultrasound guided percutaneous microwave ablation. Intraoperative ＂heat blocking blood flow＂ was used to prevent severe hemorrhage. ＂ Liquid isolation belt＂ and ＂ leverage from＂ methods were used to effectively prevent surrounding important structures against heat damage. ＂Small amount of residual method＂ was used to avoid tracheal collapse. All patients were followed up post-operative 1,3,6, 12 months by monitoring of thyroid nodule volume change, adverse reactions, and postoperative complications. Results Thirteen patients with 47 medals nodules were successfully performed percutaneous microwave ablation guided by ultrasound. Among them, 2 patients performed the second treatment for too large volume of goiter, tracheal displacement and poor physical tolerance of older. The postoperative ultrasound contrast and color Doppler showed that the lesions were completely inactivated. No obvious complications occurred in all 13 patients, and no permanent hoarseness occured. The symptoms of cervical oppression and discomfort disappeared for all patients within 1 - 4 months after surgery. Thirteen patients were followed up for 12 months after the operation. The thyroid function was normal and the volume reduction rate of thyroid nodules was （85 ± 31） %. Conclusions Percutaneous microwave ablation of type I substernal goiter under ultrasonic guidance is a safe and effective method to reduce the thyroid nodules with no serious complications. It is worth to be popularized in clinical practice.

关 键 词：超声检查 微波/治疗应用 甲状腺肿 胸骨后 

分 类 号：R653[医药卫生—外科学]