微波消融治疗良性甲状腺结节对甲状腺自身抗体及甲状腺功能的影响  

Microwave Ablation for the Treatment of Benign Thyroid Nodules Effects on Thyroid Function and Thyroid Autoantibodies

作　　者：刘裕[1] 黄汉伟[1] 熊晓慧 蔡雪[1] 林旋霞 张文娟[1] 

机构地区：[1]广东省中山市陈星海医院(广东医科大学附属中山医院),广东中山528415

出　　处：《中国医学创新》2017年第12期43-47,共5页Medical Innovation of China

基　　金：中山市社会公益科技局项目(医疗卫生)(2016B1102)

摘　　要：目的:探讨超声引导下微波消融治疗良性甲状腺结节的效果,以及该技术对甲状腺自身抗体和甲状腺功能的影响。方法:回顾性分析本院在超声引导下微波消融治疗的50例良性甲状腺结节患者,观察消融术后的活检病理报告和术前、术后的超声特征(边界、结节组成、血管、钙化、纵横比),以及微波消融治疗后患者的甲状腺自身抗体如甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)的变化,将术后的甲状腺激素如促甲状腺激素(TSH)、甲状腺素(T_4)、三碘甲状腺原氨酸(T_3)、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT_3)与术前的水平进行比较,评估微波消融治疗对甲状腺自身抗体及功能的影响。结果:50例患者手术均成功。术后1、3、6、12、18个月的甲状腺结节体积均小于术前,差异均有统计学意义(P<0.05)。术后1周、3个月、6个月的TGAb、TPOAb与术前比较,差异均有统计学意义(P<0.05);术后12个月的TPOAb与术前比较,差异也有统计学意义(P<0.05)。微波消融后即刻对甲状腺结节进行病理活检,100枚活检标本肉眼观可呈淡黑色或浅褐色,病理图片提示活检的结节细胞已变性、凝固、坏死、细胞核固缩。结论:采用超声引导下微波消融治疗良性甲状腺结节,具有微创、安全、有效、美观、并发症少、可控性强、疗效确切等优势,可能发生甲状腺自身抗体一过性阳性,对正常甲状腺功能区组织影响甚微。Objective： To investigate the effect of ultrasound guide microwave ablation in the treatment of benign thyroid nodules, and the effects of this technique on thyroid autoantibodies and thyroid function.Method： Retrospective analysis of 50 cases of benign thyroid nodules treated by ultrasound-guided microwave ablation in our hospital, the pathological features of biopsy and the ultrasonic features （ boundary, nodule composition, blood vessel, calcification, aspect ratio） before and after ablation were observed, changes of thyroid autoantibodies such as thyroid peroxidase antibody （ TPOAb ） and thyroglobulin antibody （ TGAb ） in patients after microwave ablation, the postoperative thyroid hormones such as thyroid stimulating hormone （ TSH ）, thyroxine （ T4 ）, three triiodothyronine （ T3 ）, free thyroxine （ FT4 ）, free three triiodothyronine （ FT3 ） compared with the preoperative level, the effects of microwave ablation on thyroid autoantibodies and function were evaluated. Result： 50 cases were all successful.The volume of thyroid nodules in 1, 3, 6, 12, 18 months after operation were less than that before operation, the differences were statistically significant （ P〈0.05 ） .After operation 1 week, 3 months, 6 months, the TGAb and TPOAb were compared before operation, the differences were statistically significant （ P〈0.05 ） ; the difference of TPOAb between 12 months after operation was statistically significant （ P〈0.05 ） .The pathological examination of thyroid nodules was performed immediately after microwave ablation, the 100 biopsy specimens showed pale or dark brown in the naked eye, and the pathological images showed that the nodules had been changed, coagulated, necrotic and pyknosis.Conclusion： Using ultrasound guide microwave ablation for the treatment of benign thyroid nodules, minimally invasive, safe and effective, less complications, beautiful appearance, strong controllability, curative effect and other advantages, may have a positive thyroid

关 键 词：微波消融 甲状腺功能 良性甲状腺结节 甲状腺自身抗体 

分 类 号：R653[医药卫生—外科学]