改良超声引导下微波消融术治疗甲状腺微小乳头状癌的优势  

Advantages of improved ultrasound-guided microwave ablation for treat⁃ment of papillary thyroid carcinoma

作　　者：杨春雪[1] 于春英 YANG Chun-xue;YU Chun-ying(Department of Ultrasound,Harbin 242nd Hospital,Harbin 150060,China)

机构地区：[1]哈尔滨二四二医院超声科,黑龙江哈尔滨150060

出　　处：《中国现代普通外科进展》2025年第3期180-184,共5页Chinese Journal of Current Advances in General Surgery

基　　金：黑龙江省教育厅科学技术研究项目(21231258)。

摘　　要：目的:探究基于免疫功能、创伤应激状态、并发症评价的改良超声引导下微波消融术对甲状腺微小乳头状癌(PTMC)的治疗优势。方法:选取2021年1月—2024年3月于哈尔滨二四二医院手术的129例PTMC患者,随机分为对照组64例和试验组65例。对照组采用传统手术治疗,试验组采用改良超声导引下微波消融术。比较两组免疫功能测量指标:CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及白介素-2(IL-2)、干扰素-γ(IFN-γ)、白介素-4(IL-4)、白介素-10(IL-10);创伤应激指标:白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及并发症发生情况。结果:术前,两组T淋巴细胞亚群所有指标比较差异无统计学意义(P>0.05);术后1 d及术后2周,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均较术前升高,CD8^(+)较术前降低(P<0.05),且两组比较差异也有统计学意义(P<0.05)。术前,两组Th1型细胞因子(IL-2、IFN-γ)、Th2型细胞因子(IL-4、IL-10)比较差异无统计学意义(P>0.05);术后1 d,两组IL-2、IFN-γ、IL-4及IL-10均较术前升高(P<0.05);术后2周,两组IL-2、IFN-γ较术后1 d降低,但较术前仍升高(P<0.05),IL-4、IL-10较术后1 d及术前均降低(P<0.05),且两组比较差异有统计学差异意义(P<0.05)。Th1/Th2术前两组比较差异无统计学意义(P>0.05);术后1 d及术后2周,两组Th1/Th2均较升高(P<0.05),且试验组升高程度高于对照组(P<0.05)。术前,两组IL-6及TNF-α差异无统计学意义(P>0.05);术后1 d,两组IL-6及TNF-α均升高,对照组升高程度大于观察组(P<0.05);术后3 d,两组IL-6以及TNF-α较术后1 d下降,但对照组仍高于试验组(P<0.05);试验组IL-6及TNF-α术后3 d与术前比较差异无统计学意义(P>0.05),对照组IL-6及TNF-α术后3 d与术前比较差异有统计学意义(P<0.05)。随访12个月后,试验组的并发症发生率为16.92%,对照组的并发症发生率为39.06%,前者明显低于后者(P<0.05)。结论:改良超声引导下微波消融术较传统外科手术而�Objective:To evaluate the advantages of modified ultrasound-guided microwave ablation in the ment of thyroid micropapillary carcinoma(PTMC)based on immune function,traumatic stress status and complications.Methods:A total of 129 patients with PTMC who underwent surgery in Harbin 242nd hospital from January 2021 to March 2024 were selected as test subjects,and the test subjects were randomly divided into the control group(64 cases)and the test group(65 cases).The control group was treated with traditional surgery,and the experimental group was treated with improved ultrasound-guided microwave ablation.The immune function measures of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)and interleukin-2(IL-2),interferon-γ(IFN-γ),interleukin-4(IL-4)and interleukin-10(IL-10)were compared between the two groups.Traumatic stress indicators:interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and the occurrence of complications.Results:Before surgery,there was no significant difference in all T lymphocyte subsets between the two groups(P>0.05).CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in both groups were higher on the 1st day and 2 weeks after surgery compared with presurgery leves,and CD8^(+)was lower(P<0.05),and the difference between the two groups was statistically significant(P<0.05).Before operation,there was no significant difference in Th1 cytokines(IL-2,IFN-γ)and Th2 cytokines(IL-4,IL-10)between the two groups(P>0.05).The levels of IL-2,IFN-γ,IL-4 and IL-10 in 2 groups were higher than those before surgery(P<0.05).At 2 weeks after surgery,IL-2 and IFN-γwere lower than that at 1d after surgery,but still higher than before surgery(P<0.05),IL-4 and IL-10 were lower than that at 1d after surgery and before surgery(P<0.05),and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in Th1/Th2 between the two groups before surgery(P>0.05).On the first day and 2 weeks after surgery,Th1/Th2 in both groups was increased(P<0.05),and the degree of increase in test group was higher tha

关 键 词：免疫功能 创伤应激状态 并发症 改良超声引导 甲状腺微小乳头状癌 

分 类 号：R736.1[医药卫生—肿瘤]