微波消融治疗T1N0M0乳头状甲状腺癌伴包膜侵犯的初步研究  

Preliminary study of microwave ablation for T1N0M0 stage papillary thyroid carcinoma with concomitant capsule invasion

作　　者：吴萍[1] 秦敏[1] 李尊[1] 钱丰[2] WU Ping;QIN Min;LI Zun;QIAN Feng(Department of Ultrasound,Affiliated Wujin Hospital of Jiangsu University(Wujin Clinical College of Xuzhou Medical University),Changzhou,Jiangsu Province 213000,China)

机构地区：[1]江苏大学附属武进医院(徐州医科大学武进临床学院)超声科,江苏常州213000 [2]苏州大学附属第三医院超声科,江苏常州213000

出　　处：《介入放射学杂志》2023年第10期975-979,共5页Journal of Interventional Radiology

基　　金：江苏省卫生健康委2019年度医学科研立项项目(H2019016)。

摘　　要：目的探讨超声引导微波消融治疗T1N0M0乳头状甲状腺癌(PTC)伴包膜侵犯的可行性和有效性。方法选择2017年3月至2021年9月江苏大学附属武进医院和苏州大学附属第三医院病理确诊PTC伴包膜侵犯(T1N0M0)患者共86例,采用超声引导下延长和多点微波消融以及液体隔离策略治疗。并采用超声造影测量消融术前1 d和消融后1、3、6、12个月的肿瘤最大直径和体积变化,检测消融前和消融后1、3、6、12个月血清甲状腺激素水平。记录随访12个月肿瘤进展率(包括局部复发、新发病灶和淋巴结转移)和并发症。结果所有患者均成功完成微波消融术和术后12个月的临床随访,消融总时间50~185s,平均(135±60)s,水分离体积30~80 mL,平均(52±16)mL。术后1个月肿瘤最大直径和体积较术前显著增加,随后逐渐缩小(P<0.05)。63例(73.3%,63/86)肿瘤完全消失,未检测到局部复发。消融前后各时间点促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和甲状腺素(FT4)水平均无显著变化,均在正常参考范围(P>0.05)。所有患者术后均未常规应用甲状腺替代药物。7例(8.1%,7/86)出现肿瘤进展,其中6例为新发病灶、1例为淋巴结转移,经二次消融后肿瘤完全消失。轻度嗓音改变(5.8%,5/86)是唯一主要并发症,术后6个月内缓解。结论超声引导微波消融治疗T1N0M0期PTC伴包膜侵犯具有较好的安全性和临床疗效,值得推广应用。Objective To investigate the feasibility and effectiveness of ultrasound-guided microwave ablation(MWA)for TINOMO stage papillary thyroid carcinoma(PTC)with concomitant capsule invasion.Methods A total of 86 patients,who were pathologically proved to suffer from PTC with concomitant capsule invasion(TINOMO)at the Affiliated Wujin Hospital of Jiangsu University and the Third Affiliated Hospital of Soochow University of China between March 2017 and September 2021,were enrolled in this study.All patients received ultrasound-guided extended,multi-point MWA,and the liquid isolation treatment strategy was employed.Contrast-enhanced ultrasound(CEUS)was performed to measure the maximum diameter and volume of the tumors at one day before MWA as well as at one,3,6,and 12 months after MRA.The pre-MRA,and post-MRA one-,3-,6-,and 12-month serum thyroid hormone levels were determined.The post-MRA 12-month tumor progression rates(including local recurrence,newly-developed lesions,and lymph node metastasis)and complications were calculated.Results Successful MWA and clinical follow-up for 12 months were accomplished in all 86 patients.The mean ablation time was(135±60)seconds(range of 50-185 seconds).The mean water separation volume was(52±16)mL(range of 30-80mL).One month after MWA,the maximum diameter and volume of tumor were increased significantly when compared with the pre-MWA ones,then,both of them were gradually and remarkably decreased(P<0.05).Complete disappearance of tumor was seen in 63 patients(73.3%,63/86),and no local recurrence was observed.The levels of thyroid stimulating hormone(TSH),free triodothyronine(FT,)and thyroxine(FTA)showed no obvious changes at each time point before and after MWA,all of TSH,FTsand FT4levels were within the normal reference ranges(P>0.05).None of the patients routinely received thyroid replacement drugs after MWA.Tumor progression was found in 7 patients,including newly-developed lesions(n=6)and lymph node metastasis(n=1),which were completely vanished after receiving a second MWA t

关 键 词：超声造影 微波消融 乳头状甲状腺癌 包膜侵犯 甲状腺激素 并发症 

分 类 号：R736.1[医药卫生—肿瘤]