射频消融术在弥漫性毒性甲状腺肿中的应用  

Application of radiofrequency ablation in treating diffuse toxic goiter

作　　者：邱秀萍 张婷 陈阳[1] 黄汝哨 王炜 陈杭菊 邱思花[2] 涂梅[1] QIU Xiuping;ZHANG Ting;CHEN Yang;HUANG Rushao;WANG Wei;CHEN Hangju;QIU Sihua;TU Mei(Departmentof Endocrinology,Longyan Municipal First Hospital,Longyan,Fujian Province 364000,China)

机构地区：[1]龙岩市第一医院内分泌科,福建龙岩364000 [2]龙岩市第一医院超声科,福建龙岩364000

出　　处：《介入放射学杂志》2023年第9期871-874,共4页Journal of Interventional Radiology

基　　金：龙岩市科技计划项目(2020FLY17023)。

摘　　要：目的探讨超声引导下射频消融(RFA)治疗弥漫性毒性甲状腺肿(Graves病)的疗效。方法纳入20例Graves病患者,超声引导下行RFA术,将甲状腺近全消融,仅保留甲状腺危险三角处2~3 mm。比较术后1、3 h疼痛视觉模拟量表(VAS)评分;术后1、3、6、12个月复查甲状腺功能、甲状腺彩超,计算甲状腺体积、甲巯咪唑用量。结果20例Graves病患者的年龄为(36.4±9.2)岁,病程为(7.10±1.57)年,术前甲状腺体积为(38.14±8.19)cm^(3),术前甲巯咪唑用量为(9.50±2.23)mg。术后1年7例患者停药,停药者术前TRAb<10 IU/L,甲状腺体积为(30.14±4.19)cm^(3)。术后随着时间延长,甲状腺体积、TRAb、甲巯咪唑用量逐渐减少。术后1年甲状腺体积和TRAb与1年后甲巯咪唑用量呈正相关。20例患者中,治疗有效18例,2例术后1年FT3、FT4、TSH仍异常,甲巯咪唑用量较术前无减量。冰敷组VAS评分为2~3分,非冰敷组为2~5分。术后1 h冰敷组VAS评分秩平均值为6.1,非冰敷组为14.9(Z=-3.50,P<0.01);术后3 h分别为8.5和12.5(Z=-1.78,P=0.075)。不良反应主要是疼痛、颈部肿胀、声音嘶哑。结论超声引导下RFA治疗Graves病不良反应小,疗效显著,部分患者仍需小剂量抗甲亢药物维持,TRAb<10 IU/L、甲状腺体积较小者有望停药。Objective To discuss the curative efficacy of ultrasound-guided radiofrequency ablation(RFA)in the treatment of diffuse toxic goiter(Graves'disease).Methods A total of 20 patients with Graves*disease were enrolled in this study.All patients received ultrasound-guided RFA,and the thyroid gland was almost completely ablated with retaining only 2-3 mm tissues of the thyroid hazard triangle.The postoperative one-hour and 3-hour visual analogue scale(VAS)scores were calculated and compared.The thyroid function and thyroid color ultrasound were examined at 1,3,6,and 12 months after RFA,and the thyroid volume and methimazole dosage were calculated.Results The mean age of the 20 patients with Graves'disease was(36.4±9.2)years,the mean course of disease was(7.10±1.57)years.The preoperative thyroid volume was(38.14±8.19)cm^(3),and the preoperative dosage of methimazole was(9.50±2.23)mg.Seven patients stopped taking the drug one year after RFA,in whom the preoperative thyrotropin receptor antibody(TRAb)<10 IU/L,the thyroid volume was(30.14+4.19)cm^(3).After RFA,the thyroid volume,TRAb level,and methimazole dosage gradually decreased over time.One year after RFA,the thyroid volume and TRAb level were positively correlated with the used dosage of methimazole.Among the 20 patients,effective response was obtained in 18 patients,in 2 patients the postoperative one-year FTs,FT4,and TSH levels remained abnormal,and the used dosage of methimazole was no significant less than the preoperative dosage.The VAS score in ice-compress group was 2-3 points,while in non-ice-compress group was 2-5 points.The postoperative one-hour rank average value of VAS score in the ice-compress group was 6.1 points,which in the non-ice-compress group was 14.9 points(Z=-3.50,P<0.01).The postoperative 3-hour rank average value of VAS scores in the icecompress group and non-ice-compress group were 8.5 points and 12.5 points respectively(Z=-1.78,P-0.075).The adverse effects were mainly pain,neck swelling,and hoarseness.Conclusion For the treatment of Gra

关 键 词：射频消融 弥漫性毒性甲状腺肿 甲巯咪唑 

分 类 号：R653[医药卫生—外科学]