超声引导下激光消融甲状腺良性结节实验研究及临床应用

发布时间：2018-04-28 04:05

本文选题：猪甲状腺 + 激光消融　；参考：《中南大学》2014年硕士论文

【摘要】：目的：探讨在超声引导下不同功率及不同能量作用下激光消融离体猪甲状腺组织的消融形态、范围、温升曲线等参数,评估其有效性、安全性及可行性,确定消融甲状腺组织的最佳功率及总能量,为激光消融甲状腺结节的临床应用提供参考。材料与方法：采用意大利百胜医疗ECHO LASER集成激光介入超声系统。在超声引导下对新鲜离体猪甲状腺采用不同能量组合进行激光消融,消融功率分别采用1W、2W、3W、4W、5W、6W、7W,能量为300J、600J、900J、1200J、1500J、1800J、消融的同时采用热电偶在距离光纤Omm、5mm、10mm及15mm处进行实时测温。消融术后对消融组织做病理学检查证实消融效果,并对各组的消融情况进行比较。结果：消融区域大致呈椭圆形,超声表现为中央强回声区,周边稍强回声区,后方回声可见衰减。切开后,肉眼观察消融区域中央为碎渣样碳化包绕的空腔,周边为灰白色或浅黄色坏死组织。HE染色显示：消融区中央呈规则的类椭圆形的空洞区,几乎无染色剂浸染,周边可见一层较薄的碳化层,最外围为坏死的甲状腺滤泡。光镜下显示：中央呈“空洞状”,周边甲状腺组织滤泡减少,滤泡上皮收缩,上皮细胞核明显固缩。温度显示：功率≥2W各组光纤中心及距离光纤5mm处温度均超过60℃。统计学结果得出：功率3W、能量为1200-1800J,消融范围差异有统计学意义(P0.05)。结论：超声引导下激光消融离体正常猪甲状腺组织安全性高、效果明确、消融范围稳定；消融范围随着功率及能量的增加而增加,本实验得出功率为3W,能量为1200-1800J时,可获得最佳消融效果。图8幅,表2个,参考文献28篇。背景：激光消融是近年来发展起来的一种微创治疗方法,目前已有不少关于激光消融的文献报道,但鲜有关于甲状腺结节激光消融根治治疗的文献报道。目的：通过超声引导下激光消融甲状腺良性结节,探讨超声引导下经皮激光消融治疗甲状腺良性结节的可行性、安全性及临床价值。方法：2012年9月到2014年4月间在我院行超声引导下激光消融治疗甲状腺良性结节的患者共90例118个病灶。术前常规检查甲状腺功能并评估临床症状,并采用常规超声及超声造影评估所有甲状腺结节的大小及增强情况。消融功率设置为3W。消融方法根据结节大小决定采取单针、多针或多点消融。术后1天进行超声造影评估结节的完全消融情况。术后1,3,6,12,18个月的随访期进行甲状腺结节体积、甲状腺功能、临床症状及并发症等的评估。本研究经我院伦理委员会批准,所有患者均获得了知情同意并签署书面知情同意书。结果：所有甲状腺良性结节均成功进行了消融治疗。其中结节的最大长径≤1cm的结节一次性消融率为97.1%,≤2cm的结节一次性消融率为91.2%,2cm的结节一次性消融率为62.5%。术后常规超声随访所有结节体积较消融后1天明显减小(P0.05),在最终评估时结节最大直径从1.01±0.64cm减少到0.83±0.56cm,体积从0.30±0.37ml减少到0.17±0.20m1,最终随访结节平均体积减少率为71.8%。25.4%(30/118)结节消融术后12个月完全消失。治疗前与术后1个月比较甲状腺功能没有明显不同(P0.05)。激光消融治疗的耐受性良好,3例患者术中有明显疼痛感,1例(1.1%)患者出现喉返神经损伤,治疗后6个月内声音恢复正常。结论：超声引导下激光消融可有效灭活甲状腺良性结节,尤其适用于≤2cm的甲状腺良性结节。激光是一种美容效果好、非常安全、有效的潜在可行的微创治疗技术,有望成为外科手术治疗甲状腺良性结节的重要补充。图9幅,表2个,参考文献27篇。
[Abstract]:Objective: To investigate the ablation morphology, range, temperature rise curve and other parameters of laser ablation of pig thyroid tissue under different power and different energy effects under ultrasound guidance, to evaluate its effectiveness, safety and feasibility, to determine the optimal power and total energy of the ablation thyroid tissue, and to provide the clinical application of laser ablation of thyroid nodules. Reference resources.
Materials and methods: using Italy Baisheng medical ECHO LASER integrated laser interventional ultrasound system. Under the guidance of ultrasonic guidance, the fresh isolated pig thyroid gland is laser ablation with different energy combinations. The ablation power is 1W, 2W, 3W, 4W, 5W, 6W, 7W, and the energy is 300J, 600J, 900J, etc., at the same time using thermocouples at the distance simultaneously. Real-time temperature measurement was performed at Omm, 5mm, 10mm, and 15mm. Ablation results were confirmed after ablation, and the ablation conditions were compared in each group.
Results: the ablation area was roughly elliptical, the ultrasound showed a central strong echo area, the peripheral strong echo area and the posterior echo were attenuated. After the incision, the center of the ablation area was observed in the center of the ablation area for the crumb like carbonized cavities, and the surrounding area was gray or light yellow necrotic tissue.HE staining: the center of the ablation area was in a regular oval shape. In the empty area, there were almost no dyed stains, a thin layer of carbonized layer and the most peripheral thyroid follicular in the periphery. The light microscope showed that the center was "hollow", the peripheral thyroid follicles decreased, the follicle epithelium contracted and the epithelial nuclei were obviously retracting. The temperature shows: the optical fiber center and the distance from the fiber 5mm of each group of power more than 2W The temperature was above 60 C. Statistical results showed that power 3W and energy were 1200-1800J, and the difference of ablation range was statistically significant (P0.05).
Conclusion: the ultrasound guided laser ablation of normal pig thyroid tissue is safe, the effect is clear, the ablation range is stable, the ablation range increases with the increase of power and energy. The best ablation effect can be obtained when the power is 3W and the energy is 1200-1800J. Figure 8, table 2, 28 references.
Background: laser ablation is a minimally invasive treatment method developed in recent years. There have been a lot of literature about laser ablation, but there are few literature reports about the radical treatment of laser ablation of thyroid nodules.
Objective: To investigate the feasibility, safety and clinical value of ultrasound guided percutaneous laser ablation for the treatment of benign thyroid nodules under ultrasound guided laser ablation.
Methods: 90 patients with 118 lesions were treated with ultrasound guided laser ablation in our hospital from September 2012 to April 2014. The thyroid function was examined and the clinical symptoms were evaluated before operation. The size and enhancement of all thyroid nodules were evaluated by conventional ultrasound and ultrasound contrast. The ablation power was set to 3W. A single needle, multiple or multi point ablation was taken according to the size of the nodules. The total ablation of the nodules was assessed by contrast-enhanced ultrasound 1 days after the operation. The volume of thyroid nodules, thyroid function, clinical symptoms and complications were evaluated at a follow-up period of 1,3,6,12,18 months after the operation. All patients were approved by our Institute of ethics. All of them obtained informed consent and signed written informed consent.
Results: all thyroid benign nodules were successfully treated with ablation. The one-time ablation rate of nodules with the maximum diameter of less than 1cm was 97.1%, the one-time ablation rate of nodules less than 2cm was 91.2%. The one-time ablation rate of 2cm nodules was 62.5%. after 62.5%., and all nodal volumes decreased significantly (P0.05) after 1 days after ablation. The maximum diameter of nodules decreased from 1.01 + 0.64cm to 0.83 0.56cm, and the volume decreased from 0.30 + 0.37ml to 0.17 + 0.20m1. The average volume reduction rate of final follow-up nodules was completely disappeared after 12 months after 71.8%.25.4% (30/118) ablation. There was no significant difference between the thyroid gland function and laser ablation before and 1 months after the treatment (P0.05). The treatment was well tolerated. 3 patients had significant pain during operation. 1 patients (1.1%) had recurrent laryngeal nerve injury, and their voice returned to normal within 6 months after treatment.
Conclusion: ultrasound guided laser ablation can effectively inactivate thyroid benign nodules and is especially suitable for thyroid benign nodules less than 2cm. Laser is a good, safe and effective minimally invasive technique for the treatment of thyroid benign nodules. It is expected to be an important supplement to the surgical treatment of thyroid benign nodules. Figure 9, table 2, reference 27 articles.

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1;R445.1

【参考文献】