甲状腺病变的热消融治疗多中心研究及相关流行病学调查

发布时间：2018-07-17 06:08

【摘要】：目的：对微波消融治疗良性甲状腺病变临床应用的具体技术，评价方法、疗效和安全性做进一步研究，对恶性病变治疗的可行性进行探索。方法：选取2010年11月至2014年04月在我科行超声引导下微波消融治疗的甲状腺良性结节患者76例共88个结节，平均直径3.2±1.6cm；甲状腺恶性病灶共7例7个病灶消融均采用水冷微波天线及康友（南京）KY-2000型微波消融治疗仪（频率2450MHz）进行治疗。选取其中22例25个病灶于术前及术后进行弹性成像并测定弹性指数（E）及弹性比率值（Ratio）进行定量分析。其中按照消融方式将病灶分为固定针消融组（n=42）和移动消融组（n=39），并分阶段统计两组及总体的病灶缩小率，比较两组消融手术参数、消融范围及缩小率间的差异。结果：随访1-26个月，结节缩小率为51.23±31.97%。消融治疗后疼痛及症状评分、血流评分及美观评分均降低（p0.05)。消融后出现甲状腺功能指标TT3、游离TT4的升高和TSH的降低具有统计学差异(p0.01)。消融后E值高于消融前（P=0.008），其中实性为主及病理为腺瘤的病灶E值升高明显（p=0.041；p=0.036）。移动消融组治疗单位体积用时较固定消融组短（p=0.027）各阶段体积缩小率均高于固定消融组，，其中3-6个月时有统计学意义（p=0.041）。结论：微波消融治疗甲状腺良性结节的效果确实，对患者颈部美观改善明显，副作用和并发症少且轻。采用移动消融技术疗效确切且治疗效率更高，消融范围更适形更完全。手术前后采用组织弹性定量分析对于实性为主及腺瘤性质的病灶有一定应用价值，有望成为术中无创检测消融范围的方法。微波消融可以用于单发无明确腺体外及淋巴结转移的甲状腺恶性病灶治疗。该方法虽尚不能替代手术，但在判断好适应症的情况下选择合适病例进行局部消融治疗是可行的。目的：本研究的目的是分析北京地区居民甲状腺肿及甲状腺结节的发病影响因素及患病特征，并从流行病学角度探讨开展热消融治疗甲状腺病变的前景。方法：通过整群抽样选择北京市城区及郊区常住居民10000名，年龄18-75岁，无严重器官功能损害，进行病史采集、问卷调查及超声检查，并获得完整资料6323例，男性2263例，女4060例，平均年龄为51.44±11.72岁。对该地区甲状腺肿及甲状腺结节患病率，患病特征及相关影响因素进行统计和分析。结果：经超声筛查得到的甲状腺肿及结节的总患病率为57.68％，女性患病率明显高于男性，（p＜0.001），并且患病率随年龄增长而逐渐增加。该地区人群男女间甲状腺结节的单多发比例间的差异（p=0.001)，男性以单发结节多见，女性则多发结节的比例更高。年龄、性别、高血压病、糖尿病、吸烟等多种因素影响该地区结节的患病率（p＜0.05）。结论：北京地区甲状腺肿及甲状腺结节的患病率高，患病影响因素较多，疾病的预防应注重对生活习惯的纠正及基础疾病的控制。部分患者采用现有方式治疗不理想或不适合，需要疗效确切、可重复、适应症更广的新方法。目的：通过开展前瞻性的大样本量多中心研究，对热消融治疗主要技术（微波、射频、激光）的临床应用情况进行对比，以期得出热消融疗效、安全性以及操作方法的更全面可靠的高级别的循证医学数据。方法：选取2013年2月至2014.3月之间在中国12家医院接受超声引导下热消融治疗甲状腺良性结节的患者340例共437个病灶，平均年龄46.23±12.47岁。分别采取射频、微波、激光三种技术进行消融治疗。消融前后行超声及造影检查评价结节的初始大小及消融范围，对患者治疗前后的临床症状体征、颈部外观、结节血流等主观评价指标进行量化评分，记录并发症的情况。结果：随访1-12个月，得到结节缩小率为63.72±68.87%，消融治疗后血流评分、美观评分及疼痛症状评分均降低明显（p0.01)。消融后出现甲状腺功能指标TT3、TT4、fT3、fT4的升高和TSH的降低(p0.001)。分别采用射频消融、微波消融、激光消融治疗病灶数量分别为236个、199个、3个，对射频消融及微波消融进行对比分析得到微波组治疗时间短，且术后缩小率高于射频组（p＜0.05）。结论：热消融治疗甲状腺良性结节的疗效确切，安全性较高。中期结果表明研究进展基本达到预期，纳入考量的指标均有阳性结果，暂无需调整研究方案，但尚需补充激光消融病例作为对比参照。
[Abstract]:Objective: To study the specific techniques, evaluation methods, efficacy and safety of microwave ablation in the treatment of benign thyroid lesions, and to explore the feasibility of the treatment of malignant lesions. Methods: 76 cases of benign thyroid nodules treated by ultrasound guided micro wave ablation in our department from November 2010 to 04 2014 were selected. A total of 88 nodules, with an average diameter of 3.2 1.6cm, were treated with water cooled microwave antenna and KY-2000 type microwave ablation therapy instrument (frequency 2450MHz) in 7 cases of malignant thyroid lesions. 22 of them 25 lesions were selected before and after operation, and the elastic index (E) and elastic ratio were measured (Ratio The lesions were divided into fixed needle ablation group (n=42) and mobile ablation group (n=39) according to the method of ablation. The two groups and the overall reduction rate of focus were statistically analyzed. The differences of ablation operation parameters, ablation range and reduction rate were compared between the two groups. The results were followed up for 1-26 months, the reduction rate of nodules was 51.23 + 31.97%. ablation treatment. After the ablation, the score of pain and symptoms, the score of blood flow and the aesthetic score were all decreased (P0.05). The thyroid function index TT3, the increase of free TT4 and the decrease of TSH were statistically different (P0.01). The E value after ablation was higher than that before ablation (P=0.008), in which the E value of the solid and pathological adenoma increased significantly (p=0.041; p=0.036). Movement elimination (p=0.036). The volume reduction rate in each stage of the unit volume was higher than that of the fixed ablation group (p=0.027), which was significantly higher than that in the fixed ablation group (p=0.041) at 3-6 months. Conclusion: the effect of microwave ablation in the treatment of benign thyroid nodules is indeed obvious, and the side effects and complications are less and lighter. The curative effect of the fusion technique is definite and the treatment efficiency is higher, and the ablation range is more complete.
Quantitative analysis is of certain value for solid and adenomatous lesions. It is expected to be a noninvasive method in the operation. Microwave ablation can be used for the treatment of solitary thyroid malignant lesions with no clear gland in vitro and lymph node metastases. This method can not be used instead of hand surgery, but it is selected in the judgement of good indications. It is feasible to treat appropriate cases with local ablation.
Objective: the purpose of this study was to analyze the factors affecting the incidence of goiter and thyroid nodules in Beijing residents, and to explore the prospect of heat ablation in the treatment of thyroid diseases from the epidemiological point of view. Methods: 10000 permanent residents in urban and suburban areas of Beijing were selected by cluster sampling, and the age of 18-75 years old was not serious. Organ dysfunction, medical history collection, questionnaire survey and ultrasound examination, and 6323 cases of complete data, 2263 males and 4060 females, with an average age of 51.44 + 11.72 years. The prevalence of goiter and thyroid nodules in this area, the prevalence of thyroid nodules, the characteristics of the disease and the related factors were analyzed. The total prevalence rate of adenoma and nodule was 57.68%, and the prevalence rate of female was significantly higher than that of men (P < 0.001), and the prevalence rate increased with age. The difference of single incidence of thyroid nodules between men and women in this area (p=0.001), male with single nodules, and higher proportion of multiple nodules in women. Age, sex, high blood Many factors such as pressure disease, diabetes, smoking and other factors affect the prevalence of nodules in the region (P < 0.05). Conclusion: the prevalence of goiter and thyroid nodules in Beijing region is high, and there are many factors affecting the disease. The prevention of disease should pay attention to the correction of living habits and control of basic diseases. It is suitable for a new method with definite curative effect, repeatability and wider indications.
Objective: To compare the clinical application of the main techniques (microwave, radiofrequency, and laser) for the treatment of heat ablation in order to obtain the more comprehensive and reliable evidence-based medical data of the heat ablation effect, safety and operation methods. Methods: from February 2013 to 2014.3 months. 340 cases of thyroid benign nodules were treated by ultrasound guided thermal ablation in 12 hospitals in China. The average age was 46.23 + 12.47 years old. Radiofrequency, microwave, and laser ablation were used for ablation treatment. The initial size and ablation range of the nodules were evaluated before and after ablation. The clinical symptoms, signs, neck appearance, nodular blood flow and other subjective evaluation indexes were quantified, and the complications were recorded. Results: 1-12 months of follow-up, the reduction rate of nodules was 63.72 + 68.87%. After ablation treatment, the blood flow score, aesthetic score and pain symptom score decreased significantly (P0.01). The thyroid function index was TT3 after ablation. TT4, fT3, fT4 increased and TSH decreased (p0.001). The number of lesions treated with radiofrequency ablation, microwave ablation, and laser ablation were 236, 199, 3, respectively, and compared to the radiofrequency ablation and microwave ablation, the time of microwave therapy was shorter and the reduction rate was higher than that of the radio frequency group (P < 0.05). Conclusion: heat ablation of thyroid The curative effect of benign nodules is accurate and the safety is high. The mid-term results show that the progress of the study is basically expected, and the indicators in the examination are positive, and there is no need to adjust the study scheme for the time being, but the cases of laser ablation need to be supplemented as a comparative reference.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R581

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