超声引导下射频及微波消融在甲状腺结节治疗中的应用

甲状腺结节是常见病,多发病.一般人群中,甲状腺结节触诊检出率约4%,高频超声检出率高达20%~50%[1].甲状腺结节病理分型包括良性和恶性[2].甲状腺结节中约5%的结节为恶性肿瘤[3].而良性甲状腺结节有恶变的潜能.超声检查是预测甲状腺结节性质的辅助方法.而人们更倾向于将针吸活检(fine needle aspiration biopsy,FNAB)作为评价甲状腺结节性质可靠且准确的方法,并根据细胞学病理结果决定患者进一步治疗方案.近期研究发现,针吸细胞学诊断为良性病变的甲状腺

微波消融术与传统开放手术在良性甲状腺结节治疗中对机体创伤影响的比较

目的比较超声引导下微波消融术与传统开放手术治疗良性甲状腺结节对机体的创伤,评价微波消融术在该病治疗中的应用价值.方法选择90例诊断为良性甲状腺结节需要手术治疗者,根据患者意愿分为微波消融组和传统组,其中45例选择甲状腺微波消融术,45例选择甲状腺传统手术,对2组患者术后12 h白细胞介素(IL-6),C反应蛋白(CRP)及肿瘤坏死因子α(TNF-α)进行比较.结果微波消融组术后12 h CRP(0.6±0.1)mg/L,明显低于传统手术组(11.9±2.1)mg/L(t=-35.934,P=0.000);IL-6(3.5±1.2)ng/L,明显低于传统手术组(14.3±4.4)ng/L(t=-15.885,P=0.000);TNF-α(43.1±6.1)ng/L,明显低于传统手术组(50.1±2.7)ng/L(t=-7.039,P=0.000).微波消融组术中出血量(12.3±2.1)ml,明显少于传统手术组(29.2±4.1)ml(t=-24.610,P=0.000);手术时间(29.4±5.4)min明显短于传统手术组(82.2±14.8)ml(P=-22.482,t=0.000);住院时间(1.6±0.7)d明显短于传统手术组(4.2±0.4)d(t=-21.633,P=0.000).2组术后并发症发生率无显著差异(微波消融组4例,传统手术组6例,χ2=0.450,P=0.502).结论超声引导下微波消融治疗甲状腺良性结节较传统手术创伤小,美观,术后恢复快,疗效确切,值得临床推广.

超声引导下微波消融术治疗良性甲状腺结节的疗效及安全性分析

Objective: To analyze the efficacy and safety of ultrasound-guided percutaneous microwave ablation in the treatment of benign thyroid nodules. Methods: 100 patients admitted in our hospital from Jan 2013 to Jan 2015 were selected and divided into the microwave ablation group and conventional surgery group. After surgical treatment, the serum IL-6, CRP, TNF-α levels before and after treatment, duration of surgery, intra-operative blood loss, hospital stay and incidence of complications were compared between two groups. Results: After surgery, the serum levels of CRP, IL-6 and TNF-α were all higher than those before surgery in both groups, but the changes of CRP and IL-6 in microwave ablation group showed no significant difference, the level of TNF-α after surgery was lower than that of the traditional surgery group. The intra-operative blood loss (12.34 ±0.99 m L) of microwave ablation group were significantly lower than that of the conventional surgery group (28.75±2.15 m L) (P0.05). Conclusion: Ultrasound-guided percutaneous microwave ablation was safe and effective in the treatment of benign thyroid nodules without surgical scar on the body.

甲状腺结节非高温热消融治疗的现状及进展

甲状腺结节的治疗正逐步迈向微创化与精准化.传统高温热消融技术如微波消融,射频消融已被广泛应用,然而其热效应带来的潜在风险,如周围组织热损伤,热沉效应导致消融不完全等促使非高温热消融的关注日益增加.非高温热消融作用机制各异,应用场景也不尽相同.本文旨在综述非高温热消融技术的原理及该技术在甲状腺结节治疗中的应用现状与进展,重点探讨了从经典的化学消融到新兴的不可逆电穿孔,冷冻消融的治疗策略演变,为临床选择甲状腺结节的治疗方案提供新思路.