超声引导下经皮热消融治疗囊性为主混合性甲状腺结节

目的探讨超声引导下经皮热消融治疗囊性为主混合性甲状腺结节的临床应用价值。 方法选取2016年6月至2017年8月于中国科学院大学附属肿瘤医院（浙江省肿瘤医院）超声科行超声引导下热消融治疗的甲状腺结节患者21例,对21例患者的23枚囊性为主混合性良性甲状腺结节进行超声引导下经皮射频（或微波）热消融治疗。于术后即时观察手术并发症情况,并于术后第3、6、12、18个月随访,超声测量结节体积,计算结节体积缩小率（VRR）,分析热消融治疗效果。 结果21例患者在热消融过程中及术后均未出现明显血肿、出血及声音嘶哑、声音低沉、饮水呛咳等神经损伤征象。消融术后结节体积较术前呈进行性缩小,21例患者的23枚结节术后第3、6、12、18个月的VRR分别为0.733±0.045、0.823±0.039、0.904±0.034、0.933±0.026,差异有统计学意义（F=135.001,P<0.0001）。采用LSD-t方法两两比较,随访过程中各组VRR间比较,差异均有统计学意义（P均<0.01）。 结论超声引导下经皮热消融治疗囊性为主混合性甲状腺结节创伤小、安全性高、效果确切,尤其"搅拌消融法"为囊性为主混合性甲状腺结节的治疗提供了新思路,值得临床推广应用。

Ultrasound-guided percutaneous thermal ablation for treatment of predominantly cystic thyroid nodules

Objective To investigate the clinical value of ultrasound-guided percutaneous thermal ablation in the treatment of predominantly cystic thyroid nodules.Methods This study included a total of 23 predominantly cystic mixed thyroid nodules from 21 patients undergoing ultrasound-guided percutaneous thermal ablation(radiofrequency ablation or microwave ablation)at the Department of Ultrasound,Cancer Hospital of University of Chinese Academy of Sciences(Zhejiang Cancer Hospital)from June 2016 to August 2017.After thermal ablation procedures,complications were recorded.The volumes of the ablated thyroid nodules were measured,the volume reduction ratios(VRRs)of the ablated thyroid nodules were calculated,and the effects of thermal ablation were analyzed at 3-,6-,12-,and 18-month follow-ups.Results Twentyone patients had no obvious signs of hematoma,bleeding,or nerve injury such as hoarseness during and after thermal ablation procedures.The volumes of ablated nodules were progressively reduced,the VRRs of the 23 nodules in 21 patients at 3,6,12,and 18 months after thermal ablation were 0.733±0.045,0.823±0.039,0.904±0.034,and 0.933±0.026,respectively(F=135.001,P<0.0001),and there were statistically significant differences in VVRs of ablated nodules between any two follow-up time points(P<0.01 for all).Conclusion Ultrasound-guided percutaneous thermal ablation for treatment of predominantly cystic thyroid nodules has the advantages of little trauma,high safety,and definite effects.In particular,the"stirring technique"provides new ideas for the thermal ablation of predominantly cystic thyroid nodules,which is worthy of clinical promotion and application.