模拟甲状腺囊实性结节囊性成分射频和微波消融的离体实验研究  

In vitro radiofrequency and microwave ablation of cystic component in cystic-solid nodules of the thyroid

作　　者：赵丹[1] 赵齐羽[2] 王彩芬[1] 蒋天安[2] Zhao Dan;Zhao Qiyu;Wang Caifen;Jiang Tian'an(Department of Ultrasonography,Hangzhou Red cross Hospital,Hangzhou 310003,China;Department of Ultrasonography,the First Affiliated Hospital,Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江省杭州市红十字会医院超声科,310003 [2]浙江大学医学院附属第一医院超声科,杭州310003

出　　处：《中华医学超声杂志（电子版）》2022年第2期176-181,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家重大科研仪器研制项目(82027803);浙江省数理医学学会联合基金(LSY19H180015);浙江省基础公益研究计划(LGF20H180003)。

摘　　要：目的探讨甲状腺囊实性结节射频和微波消融的可行性及效能。方法使用目前常用的热消融方式(射频和微波)对甲状腺囊实性结节囊性成分的模拟液体(蒸馏水、生理盐水、血液、肝囊肿穿刺液和甲状腺囊实性结节穿刺液)进行消融。作用功率为目前临床常用的热消融功率(35W和50 W),每30 s记录温度值,连续监测10 min,绘制时间温度曲线。观察消融针针尖情况,记录针尖液体固化大小、形态及内部结构特点,必要时送病理检查。比较相同功率消融达到目标温度(60℃)的时间,并使用方差分析比较相同功率的射频和微波消融的热效能差异。结果蒸馏水仅能进行微波消融,而无法进行射频消融。35 W射频消融在生理盐水、肝囊肿穿刺液中比微波消融较早达到消融目标温度[(171.4±3.9)s vs(343.6±5.7)s、(170.2±4.8)s vs(444.5±7.2)s],时间温度曲线上具有较好的热效能(F=228.311、193.632,P均<0.001);50 W射频消融在肝囊肿穿刺液中比微波消融较早达到消融目标温度[(127.3±3.1)s vs(165.7±3.4)s],时间温度曲线上具有较好的热效能(F=47.429,P<0.001);但射频消融在血液和甲状腺囊实性结节穿刺液中无法达到消融目标温度。而50 W微波消融能在所有模拟液体中达到消融目标温度,且在血液和甲状腺囊实性结节穿刺液中的热效能明显优于射频消融(F=47.429、22.859,P均<0.001)。结论微波消融能对各甲状腺囊实性结节囊性成分的模拟液体进行消融,且性能相对稳定。射频消融热效能较高,但对蒸馏水无法消融,对血液和甲状腺囊实性结节穿刺液因针尖容易形成积碳而效果不佳。Objective To evaluate the feasibility of ablating the cystic component of cystic-solid nodules of the thyroid(CSNT)using radiofrequency ablation(RFA)and microwave ablation(MWA)in vitro.Methods The fluid simulation of CSNT cystic components in the body,like distilled water,normal saline,blood,puncture fluid of liver cyst,and the puncture fluid of CSNT,were ablated with the currently commonly used thermal ablation instruments.RFA and MWA were utilized in this study,and the ablation output power was 35 W and 50 W,respectively,which were commonly used in clinical practice.The temperature value was recorded every 30 seconds,and continuously for 10 minutes.The time temperature curve(TTC)was drawn for every test.The tip of the ablation needle was observed after the ablation,and the size,shape,and internal structure of the solidification around the needle tip were recorded.Pathological examination of the solidification around the needle tip was performed if necessary.The time of RFA and MWA to reach the target temperature(60℃)with the same power was compared,and the TTC was analyzed by variance analysis. Results Distilled water can only be ablated by MWA, but not by RFA. The targettemperature of RFA in normal saline and liver cyst puncture fluid was reached earlier than that of MWA[(171.4±3.9) s vs (343.6±5.7) s, F=228.311, P<0.001;(170.2±4.8) s vs (444.5±7.2) s, F=193.632, P<0.001] at the output power of 35 W, while at the power of 50 W, MWA had better thermal efficiency in TTC[(127.3±3.1) s vs (165.7±3.4) s, F=47.429, P<0.001]. In contrast, the target temperature in blood and thefluid punctured from CSNT was not reached. MWA at 50 W achieved the target ablation temperature in allthe simulated liquids, and the thermal efficiency in blood and the fluid punctured from CSNT were obviouslybetter than that of RFA (F=47.429 and 22.859, both P<0.001). Conclusion MWA can be used to ablate thesimulated fluid of CSNT, and the performance is relatively stable. RFA has a high thermal efficiency, but itfails to ablate distil

关 键 词：甲状腺囊实性结节 射频消融 微波消融 离体实验 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]