Clinical value of ultrasound-guided microwave ablation in the treatment of benign thyroid lesions
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摘要:
目的探讨超声引导下甲状腺微波消融治疗甲状腺良性病变的效果和安全性。 方法选取四川大学华西医院超声医学科2019年11月~2020年4月行超声引导下甲状腺微波消融治疗的甲状腺良性病变患者230例，治疗后1、3、6月复查超声，观察甲状腺结节的体积变化，检测甲状腺功能指标：游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)，检测甲状腺免疫抗体指标：抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)、抗促甲状腺素受体抗体(TRAb)，观察术后并发症。 结果与治疗前相比，甲状腺结节的体积在治疗后1、3、6月时逐渐缩小(P < 0.05)；与治疗前相比，治疗后1、3、6月的血清FT3、FT4、TSH、TGAb、TPOAb、TRAb水平差异无统计学意义(P>0.05)。患者微波消融治疗后未发生喉返神经损伤、甲状旁腺损伤、甲状腺内出血、感染等严重并发症，颈部轻中度疼痛20例(8.70%)，颈部肿胀26例(11.30%)。 结论超声引导下甲状腺微波消融治疗甲状腺良性病变具有良好的疗效和安全性，并发症少，对甲状腺功能基本无损害。 Abstract:ObjectiveTo explore the effect and safety of ultrasound- guided microwave ablation in the treatment of benign thyroid lesions. MethodsA total of 230 patients with benign thyroid lesions undergoing ultrasound-guided microwave ablation from November 2019 to April 2020 in department of ultrasound medicine, West China Hospital, Sichuan University were enrolled. Ultrasound re-examination was conducted at 1 month, 3 month and 6 months after treatment to observe the changes in volume of thyroid nodules. The thyroid function indexes [free triiodothyronine (FT3), free thyroxine (FT4), thyroidstimulating hormone (TSH)] and thyroid immune antibody indexes [anti-thyroglobulin antibody (TGAb), anti-thyroid peroxidase antibody (TPOAb), anti-thyrotropin receptor antibody (TRAb)] were detected. And postoperative complications were observed. ResultsCompared with those before treatment, the volume of thyroid nodules gradually decreased at 1 month, 3 months and 6 months after treatment (P < 0.05). Compared with those before treatment, there was no significant difference in levels of serum FT3, FT4, TSH, TGAb, TPOAb and TRAb at 1 month, 3 months and 6 months after treatment (P>0.05). After microwave ablation, there were no severe complications (recurrent laryngeal nerve injury, parathyroid injury, intrathyroid hemorrhage, infection). There were 20 cases (8.70%) with mild to moderate neck pain, and 26 cases (11.30%) with neck swelling. ConclusionThe effect and safety of ultrasound-guided microwave ablation are good in the treatment of benign thyroid lesions, with few complications and basically without damage to thyroid function. -
Key words:
- benign thyroid lesion /
- thyroid nodule /
- microwave ablation /
- ultrasound guidance /
- thyroid function
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图 1 女，26岁，甲状腺右侧叶良性滤泡性结节的超声影像图
A: 甲状腺右侧叶结节消融前二维图像, 超声显示甲状腺实质回声均匀, 右侧叶下方见大小约3.9 cm×1.4 cm×2.8 cm囊实混合回声团, 边界较清楚, 形态欠规则; B: 甲状腺右侧叶结节消融前彩色血流图像, 甲状腺结节内及周边可见点线状血流信号; C: 甲状腺右侧叶结节消融中图像; D: 甲状腺右侧叶结节消融术后图像, 可见汽化区覆盖至病灶边缘, 结节部分已消融.
Figure 1. The ultrasonic image of a 26-year-old female with benign follicular nodule in the right lobe thyroid
图 2 女，42岁，甲状腺左侧叶良性滤泡性结节的超声影像图
Figure 2. The ultrasonic image of a 42-year-old female with benign follicular nodule in the left lobe thyroid
表 1 治疗前后甲状腺结节的体积变化
Table 1. The volume changes of thyroid nodules before and after treatment (Mean±SD)
时间 体积(cm3) 体积缩小率(%) 治疗前 4.21±1.05 - 治疗后1月 2.57±0.62* 38.95±9.22 治疗后3月 1.93±0.45* 54.16±13.05 治疗后6月 1.12±0.26* 73.40±18.11 χ2/F 373.486 153.616 P < 0.001 < 0.001 *P < 0.05 vs术前. 
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表 2 治疗前后甲状腺功能指标比较
Table 2. The comparison of thyroid function indexes before and after treatment (n=230, Mean±SD)
时间 FT3(pmol/L) FT4(pmol/L) TSH(mU/L) 治疗前 4.82±1.17 17.66±4.25 1.93±0.47 治疗后1月 4.96±1.12 18.13±4.18 1.86±0.42 治疗后3月 5.02±1.24 17.29±4.36 1.90±0.45 治疗后6月 4.93±1.09 17.55±4.30 1.96±0.49 F 1.208 1.553 1.999 P 0.306 0.199 0.113 FT3: 血清游离三碘甲腺原氨酸; FT4: 游离甲状腺素; TSH: 促甲状腺激素.
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表 3 治疗前后甲状腺免疫抗体指标比较
Table 3. The comparison of thyroid immune antibody indexes before and after treatment (n=230, Mean±SD)
时间 TGAb(U/mL) TPOAb(U/mL) TRAb(U/L) 治疗前 59.31±14.72 20.18±4.93 0.80±0.18 治疗后1月 62.10±15.22 19.20±4.72 0.82±0.20 治疗后3月 60.38±14.09 19.63±5.01 0.83±0.22 治疗后6月 60.27±14.86 20.25±5.06 0.80±0.19 F 1.429 2.317 1.319 P 0.233 0.074 0.267
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