微波消融治疗甲状腺良性结节的临床研究

发布时间：2018-07-09 17:00

本文选题：甲状腺良性结节 + 微波消融　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]研究超声引导下经皮微波消融治疗甲状腺良性结节的疗效、甲状腺功能以及并发症,并与同期手术患者比较美观效果、疼痛及手术麻醉反应评分。[方法]2015年11月至2016年11月期间,选取在本院实施微波消融治疗的甲状腺良性结节患者共56例72枚结节。操作过程:术前在超声引导下行细针穿刺细胞学检查,确定结节性质后,根据病变大小和位置,制定治疗方案,按照消融操作过程进行消融。术后随访和疗效评价:消融患者术后随访1个月、3个月、6个月、12个月,采用彩色多普勒超声分别测定甲状腺结节大小、边界、内部回声、血流变化,术后第1个月行超声造影评估结节微血管损毁程度和新生血管形成,统计消融区体积、体积缩小率、甲状腺功能、并发症,并与同期手术病人比较美观效果、疼痛及手术麻醉反应评分。[结果]1.超声表现:消融完成后,原包块区域为一团状强回声区,边界清晰,后方回声轻度衰减,随访中表现为界限清晰的低回声。彩色多普勒超声显示结节内部血流信号消失,周围未消融区血流信号正常。2.病灶吸收情况:1)微波消融后第1个月,结节体积开始减小,随访结果显示可见消融区结节在术后1个月、3个月、6个月和12个月的体积出现不同程度的进行性缩小,其体积缩小率为40. 4%、58.61%、75.8%、71.81%,与术前比较差异具有统计学意义(P0. 05),其中6月时体积缩小速度最快(P0. 05 VS 3月),12月缩小速度减慢(P0. 05 VS 6月);2)术后随访期间共有39枚结节基本完全吸收,吸收率为54.17% (39/72),13枚结节随访时间小于12月,另见3枚结节复发,复发率4.17% (3/72); 3)术后1个月和3个月,混合结节组体积缩小程度较实性结节体积缩小程度更为显著,但两组结节自3个月之后的体积减小百分比无明显统计学差异;4)直径为0～20mm与31～40mm组在术后1个月时消融区的体积缩小程度较另外一组更为显著,且直径0～20mm组在术后6个月时消融区的体积缩小率大于另外两直径组,其余随访时间三组结节体积缩小无明显统计学差异。3.甲状腺功能:微波消融治疗甲状腺结节会引起少量周围正常腺体组织损伤,甲状腺功能无明显影响,无临床症状。4.并发症:1)术中即刻出现声音改变11例(19. 64%),持续时间1～2 h后自行缓解消失;2)在开展初期有4例(7.14%)患者在术后6～48 h后出现发声困难、声音嘶哑,治疗后1～3个月后,声音恢复正常;3) 3例(5.37%)出现皮肤灼伤;4) 9例(16.07%)出现血管迷走神经反应;5) 7例(12. 5%)出现疼痛,加注利多卡因缓解;6)所有患者术后出现局部不同程度术区肿胀,予冰敷及压迫处理后症状减轻。5.术后主观效果评价:通过消融组与同期手术病检良性的患者进行对比,我们发现消融组在美观效果、疼痛、手术麻醉反应评分上均明显好于手术组,差异具有统计学意义(P0. 05)。[结论]1、消融后第6月,消融区吸收速度较快,之后吸收速度慢,术后6个月可作为评价甲状腺良性结节微波消融后吸收效果的重要时间2、微波消融在美观效果、疼痛和手术麻醉反应评分的术后主观效果评价上优于手术,达到良好的微创效果。3、超声造影是检测病变微血管灌注的一种方法,可用于识别残留病灶并补充消融,还可评估消融灶范围,随访时了解复发情况。4、超声引导微波消融治疗甲状腺良性结节是一种有效、美观、并发症少的治疗方法,在掌握适应症的前提下,可以作为一种新的治疗方法。
[Abstract]:[Objective] to study the efficacy of ultrasound guided percutaneous microwave ablation in the treatment of benign thyroid nodules, thyroid function and complications, and to compare the aesthetic effect, pain and surgical anaesthesia score of the patients in the same period. [methods]2015 year November to November 2016, the thyroid benign nodules were selected in our hospital for microwave ablation. The patient had 56 cases of 72 nodules. Operation: before operation, a fine needle aspiration cytology was conducted under the guidance of ultrasonic guidance. After the nodules were determined, the treatment plan was made according to the size and position of the lesion. The ablation was performed according to the ablation operation. Postoperative follow-up and evaluation of the curative effect: the ablation patients were followed up for 1 months, 3 months, 6 months, 12 months, with color. The size, boundary, internal echo and blood flow of thyroid nodules were measured by Doppler ultrasound, and the degree of microvascular damage and neovascularization were assessed by ultrasound first months after operation. The volume of ablation area, volume reduction, thyroid function, complications, and the aesthetic effect, pain and operation anesthesia were compared with the patients in the same period. The results of]1. ultrasound showed that after the ablation was completed, the area of the original mass was a dense echo area, the boundary was clear, the posterior echo was slightly attenuated, and the follow-up showed a clear low echo. The color Doppler ultrasound showed that the blood flow signals disappeared in the nodules and the normal.2. focus absorption of the blood flow signals in the surrounding unablated area: 1) microwave elimination First months after thawing, the volume of nodules began to decrease. The follow-up results showed that the volume of the ablation zone nodules appeared at 1 months, 3 months, 6 months and 12 months after operation. The volume reduction rate was 40.4%, 58.61%, 75.8%, 71.81% (P0. 05), in which the volume decreased in June. The fastest (P0. 05 VS March), reduced speed in December (P0. 05 VS June); 2) 39 nodules were absorbed completely, the absorption rate was 54.17% (39/72), 13 nodules were followed up less than December, 3 nodules recurred, and the recurrence rate was 4.17% (3/72); 3) 1 months and 3 months after operation, the volume reduction of the mixed nodule group was more solid. The volume reduction of nodules was more significant, but there was no significant difference in the volume reduction of two groups of nodules since 3 months. 4) the size of the ablation area was more significant than the other group at 1 months after the operation, and the diameter from 0 to 20mm and 31 to 40mm was more significant than that in the other group, and the size of the ablation zone in the 0 ~ 20mm group was larger than that in the group 0 to the 6 months after the operation. In the other two diameter group, there was no significant difference in the volume of the three groups of nodules in the rest of the follow-up time.3. thyroid function: the treatment of thyroid nodules by microwave ablation could cause a small amount of peripheral normal gland tissue injury, there was no obvious effect on thyroid function, no clinical symptoms of.4. complication: 1) 11 cases (19.64%), continuous sound changes during the operation (19.64%), sustained After 1~2 h, 4 cases (7.14%) had dysphonia, hoarseness, sound hoarseness and normal sound recovery after 1~3 months of operation; 3) 3 cases (5.37%) appeared skin burns; 4) 9 cases (16.07%) appeared the vagus nerve reaction of the blood tube; 5) the occurrence of pain and lidocaine relieved. 6) all patients had local swelling in different extent after operation, and the subjective effect of.5. after operation was evaluated after ice compress and compression treatment. By comparing the ablation group with the patients with benign surgical examination, we found that the ablation group was better than the operation group in the aesthetic effect, pain and surgical anesthesia score. Study significance (P0. 05). [conclusion]1, sixth months after ablation, the absorption speed of the ablation area is faster, then the absorption speed is slow, and 6 months after the operation can be used as an important time to evaluate the absorption effect of the thyroid benign nodules after microwave ablation, and the microwave ablation is superior to the operation in the aesthetic effect, pain and surgical anesthesia score. To a good minimally invasive effect.3, contrast-enhanced ultrasound is a method for detecting microvascular perfusion, which can be used to identify residual lesions and supplement ablation, to evaluate the range of ablation range, to understand the recurrence of.4. Ultrasound guided microwave ablation for benign thyroid nodules is an effective, beautiful, and less complication treatment. Under the premise of indications, it can be used as a new treatment method.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581

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