超声引导下冷循环微波消融治疗甲状腺微小癌的临床价值

发布时间：2018-04-10 07:03

  本文选题：甲状腺微小癌　切入点：微波消融术　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的近年来由于高频率彩超以及彩超引导下细针穿刺学的使用,甲状腺微小癌在人群中的发生率较以往增高显著,对于如何治疗越来越备受关注,尤其对于一些因无法耐受手术的人群,以及术后并发症等原因拒绝外科开放手术的人群,病灶只能定期观察,但病灶仍有可能发生早期淋巴结转移。随着微波消融术近年来的发展。目前已经在肝脏恶性肿瘤以及良性甲状腺结节治疗中获取显著疗效,对其操作已经有了熟悉的掌握。因此我们将探讨B超引导下经皮冷循环微波消融(MA)治疗甲状腺微小癌的临床应用价值,避免了患者定期观察带来的危险,同时相对于传统开放手术,微波消融术具有创伤小、手术时间短、恢复快、无疤痕、并发症少等优点。虽然是一种微创,但追其原理,仍会对机体组织产生一定损伤。对于其损伤的严重性我们选取了肿瘤坏死因子α(Tumor Necrosis Factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)两种因子。它们是反应手术对机体损伤严重程度的常见指标。同时甲状腺激素是反映甲状腺功能重要指标。因此我们通过测定微波消融术前术后血清TNF-α、CRP、血清游离三碘甲腺原氨酸(f T3)、血清游离甲状腺素(f T4)、促甲状腺激素(TSH)的含量变化,以及随访中结合彩超检测甲状腺病灶消融术后体积缩小率的变化等。用以探讨该治疗方法的应用价值。方法选取2014年3月~2015年3月期间我院普外科经颈部检查考虑甲状腺微小癌的患者12例(12枚病灶),患者均在B超引导下行细针穿刺学证实为甲状腺微小癌。均无淋巴结转移且患者希望首选非开放手术治疗。患者均选择超声引导下进行甲状腺病灶的经皮穿刺冷循环微波消融术治疗。微波消融术后应用多普勒超声进行定期随访;采用ELISA法测定患者术前、术后12h的C反应蛋白(CRP)及肿瘤坏死因子(TNF-α)的指标,并进行术前与术后的比较;采用电化学发光免疫法测血清游离三碘甲腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)的含量变化,同时对术后癌灶消融区域体积缩小率进行计算以及术中出血量、住院时间以及术后并发症进行总结。结果(1)微波消融术前、术后12h CRP分别为:(0.6±0.2)mg/L、(0.6±0.3)mg/L,术前、术后TNF-α分别为(38.2±4.9)ng/L、(39.8±3.9)ng/L。微波消融术前、术后两种创伤因子均有轻微的上升,分析消融前后两种因子的变化均无统计学意义(P0.05)。(2)微波术前与术后1、3、6、12、18个月TSH的值分别为(m IU/m L):2.59±1.01、2.59±1.1、2.56±1.10、2.66±1.06、2.63±1.17、2.61±1.11;FT3的值分别为(pmol/L):4.93±0.67、4.88±0.61、4.86±0.57、4.81±0.6、4.80±0.52、4.83±0.49;FT4的值分别为(pmol/L):15.21±1.34、15.13±1.08、15.11±1.05、14.86±1.08、14.76±1.16、14.3±1.26。术前与术后TSH、FT3、FT4测得值未见明显变化,分析其结果无统计学意义(P0.05)。(3)对微波消融术后1、3、6、12、18个月的随访,其病灶体积缩小率平均分别为13.5(12.8~14.1)、42.5(32.8~50.6)、70.2(66.8~78.0)、81.0(79.0~86.2)、88.2(83.1~99.8)。(4)消融后彩超多普勒显示未受消融的正常腺体区域彩超血流信号依旧而消融区的血流信号完全丧失。甲状腺癌未见复发,周围淋巴结未见异常。(5)所有患者术中出血少,住院时间短、恢复可,术后均未见出血及血肿、剧痛、声音嘶哑、气管食管损伤及其他严重并发症。患者均对其治疗结果满意。结论微波消融术是治疗单发无淋巴结转移的甲状腺微小癌的一种微创治疗方式。具有安全、有效、创伤小、美观、术后恢复快、无手术疤痕等优点。
[Abstract]:Objective in recent years due to the high frequency ultrasound and ultrasound guided fine needle aspiration biopsy of thyroid microcarcinoma, the incidence was significantly higher than in the past, for how to treat more and more concern, especially for some of the people can not tolerate surgery, refused to open surgical operation crowd reasons and postoperative complications, lesions only regular observation, but the lesions may still occur early lymph node metastasis. With the development of microwave ablation in recent years. At present already gets obvious curative effect in liver malignant tumor and benign thyroid nodules in the treatment of the operation has been familiar with the master. So we will explore the ablation percutaneous ultrasound guided microwave (cold circulation MA) treatment of thyroid microcarcinoma clinical value, to avoid the risk of patients were observed regularly at the same time, compared with the traditional open surgery, microwave ablation. There is little trauma, short operation time, quick recovery, no scars, less complications. It is a minimally invasive, but the principle will still produce some damage to the body. For the serious injury we selected tumor necrosis factor alpha (Tumor Necrosis Factor- TNF- C, alpha, alpha) reaction protein (C-reactive protein, CRP) two factors. They are common indicators of the severity of injury surgery on the body. At the same time, thyroid hormone is an important indicator to reflect the thyroid function. Therefore we measured the microwave ablation before and after serum TNF-, CRP, serum free three triiodothyronine (f T3), serum free thyroxine (f T4), thyroid stimulating hormone (TSH) content changes, and follow-up with ultrasound detection of thyroid lesions after ablation volume reduction rate changes. In order to explore the method of treatment application value. Methods from March 2014 ~20 In March 15 during the Department of general surgery of our hospital was considered neck examination of 12 cases with thyroid microcarcinoma patients (12 lesions), patients in the ultrasound guided fine needle aspiration biopsy revealed thyroid microcarcinoma. There were no lymph node metastasis in patients with non preferred and hope open surgery patients were selected. Percutaneous microwave ablation cooling cycle the treatment of thyroid lesions under ultrasound guidance. Regular follow-up by Doppler ultrasound after microwave ablation; ELISA method was used to determine the preoperative, postoperative reaction of protein 12h C (CRP) and tumor necrosis factor alpha (TNF- alpha) index, compared with the postoperative and preoperative measurement of serum free; chemiluminescence immunoassay three triiodothyronine (FT3) by electrochemical, serum free thyroxine (FT4), thyroid stimulating hormone (TSH) content changes, at the same time of postoperative tumor ablation area size calculation and intraoperative bleeding rate, live 闄㈡椂闂翠互鍙婃湳鍚庡苟鍙戠棁杩涜�屾�荤粨.缁撴灉(1)寰�娉㈡秷铻嶆湳鍓�,鏈�鍚�12h CRP鍒嗗埆涓，

本文编号：1730159