超声引导激光消融治疗甲状腺微小乳头状癌与外科手术切除的对比研究  

Contrastive study on ultrasound-guided percutaneous laser ablation and surgical resection for papillary thyroid microcarcinoma

作　　者：季莉丽 顾军[2] 周峰[3] 樊星 郑坤[3] JI Lili;GU Jun;ZHOU Feng;FAN Xing;ZHENG Kun(Department of Ultrasondgraphy,the Affiliated Infectious Diseases Hospital of Soochow University,Suzhou 215000;Department of Ultrasondgraphy,the Affiliated Suzhou Hospital of Nanjing Medical University;Department of Ultrasondgraphy,the Affiliated Suzhou Science&Technology Town Hospital of Nanjing Medical University)

机构地区：[1]苏州大学附属传染病医院超声科,苏州215000 [2]南京医科大学附属苏州医院超声科 [3]南京医科大学附属苏州科技城医院超声科

出　　处：《南通大学学报（医学版）》2019年第4期256-260,共5页Journal of Nantong University(Medical sciences)

基　　金：苏州市科技局民生科技项目(SYSD2016063)

摘　　要：目的:探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma, PTMC)患者经超声引导下激光消融治疗与外科手术切除治疗的临床效果与安全性。方法:收集经超声引导下细针穿刺活检证实为PTMC患者46例,结节最大直径≤1.0 cm。患者分别行超声引导下激光消融(激光消融组,15例)和外科手术治疗(外科手术组,31例)。所有患者术前接受二维超声、超声造影及甲状腺激素检查,术后记录两组患者出血量及并发症情况。所有患者术后1、3、6、12个月行超声检查并复查甲状腺激素,激光消融组术后即刻、1、3、6、12个月另行超声造影检查,评估治疗后效果。结果:激光消融组患者术中出血较少,术后促甲状腺激素下降1例,1个月随访甲状腺相关激素水平正常,外科手术组术后甲状腺功能减退24例,需服用外源性甲状腺激素药物;两组患者未出现严重并发症,外科手术组术后并发症发生率为16.12%,激光消融组为6.67%;激光消融组术后12个月随访时结节体积较原病灶缩小[(6.84±23.65) mm3 vs (58.94±58.45) mm3],与消融前体积相比差异有统计学意义(P<0.05),术后12个月结节体积缩小率为88.39%;随访期间两组患者均未见复发及可疑淋巴结转移。结论:超声引导激光消融治疗PTMC具有安全、疗效好并有效保留甲状腺功能等优点,较外科手术治疗具有一定优势,是治疗PTMC的一种新型有效的微创治疗方法。Objective : To investigate the clinical efficacy and safety of ultrasound-guided laser ablation and surgical resection for patients with papillary thyroid microcarcinoma(PTMC). Methods : 46 patients with PTMC diagnosed by ultrasound-guided fine needle biopsy were collected, maximum diameter of nodules ≤1.0 cm. The patients were divided into laser ablation treatment group(n=15) and surgical treatment group(n=31), in which the ultrasound guided laser ablation and surgical treatment were performed respectively. All patients received two-dimensional ultrasound, contrast-enhanced ultrasound and thyroid hormone examination before operation and the postoperative bleeding volume and complications in two groups were recorded respectively. All patients were followed up with conventional ultrasound at 1, 3, 6, 12 months after operation and thyroid function examination was performed. The laser ablation treatment group was examined by contrast-enhanced ultrasound at immediate, 1, 3, 6 and 12 months after operation to evaluate the efficacy of the ablation. Results : The bleeding in the laser ablation treatment group was less than surgical treatment group, and thyrotropin level was found decreased in 1 patient following laser ablation and he recovered 1 month later without intervention. However, 24 patients were found hypothyroidism in surgical treatment group who recieved treatment of exogenous thyroid hormone drugs. No serious complications occurred in two groups, while the total incidence of postoperative complications in the surgical treatment group and laser ablation treatment group were 16.12% vs 6.67%, respectively. Compared with the primary focus, the nodules volume were smaller at 12 months after the laser ablation treatment group[(6.84±23.65) mm3 vs(58.94±58.45) mm3], and the difference was statistically significant(P<0.05). The reduction rate of nodule volume was 88.39% at 12 months after ablation. No recurrence and suspicious lymph node metastasis were found in the two groups during the follow-up period. Conclus

关 键 词：甲状腺微小乳头状癌 激光消融 超声检查 

分 类 号：R736.1[医药卫生—肿瘤]