超声引导经皮激光消融治疗甲状腺微小乳头状癌的疗效  

Efficacy of ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma

作　　者：张璐[1] 彭艳[1] 周伟[1] 詹维伟[1] 徐瑛 朱樱[1] 胡赟赟[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院超声科,上海200025

出　　处：《外科理论与实践》2017年第5期433-437,共5页Journal of Surgery Concepts & Practice

基　　金：上海科委医学引导项目(14411961000);上海申康医院发展中心临床辅助科室(超声医学)能力建设项目(SHDC22015006)

摘　　要：目的:采用超声引导经皮激光消融治疗甲状腺微小乳头状癌。方法 :研究对象为2013年11月至2016年6月我院61例甲状腺微小乳头状癌病人,均为单侧病灶,行超声引导经皮激光消融治疗。术后采用超声造影评估消融范围。术后1、3、6、12个月及以后每6个月,超声检查随访消融灶大小变化及复发,以及术后并发症发生。每次随访均检测甲状腺功能。术后1、6及12个月行消融灶超声引导细针穿刺活检。结果:所有病人经皮激光消融治疗成功,未发生严重并发症。病灶的最大径和体积分别从术前的(4.6±1.5)mm和(41.7±41.2)mm^3缩小至(0.7±1.4)mm(P<0.05)和(1.8±6.8)mm^3(P<0.05),平均体积缩小率为94.3%。48(78.7%)个病灶完全消失,13(21.3%)个病灶呈瘢痕样改变。术后超声引导细针穿刺活检可见坏死组织及炎性细胞,未见肿瘤细胞。1例病人术后30个月发现颈部淋巴结转移,行手术治疗。结论:超声引导经皮激光消融治疗甲状腺微小乳头状癌是安全可靠和有效、局部的治疗方法。尚需长期随访,以及与其他传统疗法的对比研究。Objective To study the efficacy of ultrasound-guided percutaneous laser ablation（PLA） of papillary thyroid microcarcinoma. Methods Sixty-one patients with unilateral papillary thyroid microcarcinomas in our hospital from November 2013 to June 2016 were treated with ultrasound-guided PLA. The extent of ablation was assessed by contrastenhanced ultrasound after PLA. Ablation zone, thyroid hormones, recurrence and complication were examined 1, 3, 6 and12 months after treatment and each 6 month thereafter. PLA complication was also evaluated. Ultrasound-guided fine needle aspiration biopsy was performed at 1, 6 and 12 months. Results All patients completed the treatment successfully and the procedure was well tolerated without major complications. The diameter reduced from（4.6±1.5） mm to（0.7±1.4） mm（P0.05） and the baseline volume from（41.7±41.2） mm^3 to（1.8±6.8） mm^3（P0.05） with the decrease 94.3%. The ablation zones 48（78.7%） had disappeared completely and 13（21.3%） remained as scar-like changes. Ultrasound-guided fine needle aspiration biopsy after PLA demonstrated inflammatory cells and necrotic tissue without viable neoplastic cell. One patient was detected neck lymph node metastasis in 30 months later after PLA and was treated by thyroid microcarcinoma resection. Conclusions Ultrasound-guided PLA of papillary thyroid microcarcinoma is safe and effective. However, longterm follow-up and the study compared with traditional treatment are needed.

关 键 词：激光消融 甲状腺微小乳头状癌 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]