四维B超引导定位穿刺结节性甲状腺肿微波消融术应用研究
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摘要
目的探究四维B超引导定位穿刺结节性甲状腺肿微波消融术的应用效果。方法回顾性分析2015年5月至2016年4月南京市第二医院外三科和江苏省人民医院普通外科收治的84例结节性甲状腺肿患者的临床资料,分为观察组和对照组,每组各42例。对照组采用甲状腺常规开放切除术,观察组采用四维B超引导定位穿刺微波消融术。对比两组患者术中出血量、手术时间、手术治疗效果、术后并发症等指标。结果观察组患者术中出血量、手术时间、住院天数、术后颈部瘢痕大小分别为(2. 36±0. 52) ml、(36. 93±5. 59) min、(3. 62±0. 58) d、(0. 43±0. 08) cm,均分别低于对照组的(30. 37±2. 85) ml、(75. 64±6. 37) min、(11. 35±1. 27) d、(3. 25±0. 57) cm,两组比较差异均具有统计学意义(P <0. 05)。术后随访24个月,两组患者结节完全消融率分别为97. 6%、100%(P> 0. 05)。观察组患者术前以及术后3、6、12个月的结节体积分别为(2. 08±0. 42)、(1. 12±0. 38)、(0. 53±0. 12)、(0. 21±0. 04) cm3(P <0. 05),观察组术后3、6、12个月的结节体积缩小率分别为46. 15%、74. 52%、89. 90%。观察组术后并发症发生率为7. 1%,低于对照组的23. 8%(P <0. 05)。结论四维B超引导定位穿刺结节性甲状腺肿微波消融术治疗效果确切,在术中出血量、手术时间、术后疗效等方面更具优势,且手术并发症较少。
Objective To investigate the application of four-dimensional B-ultrasound-guided nodular goiter puncture and microwave ablation. Methods Clinical data were retrospectively analyzed for 84 nodular goiter patients admitted to the Second Hospital of Nanjing and General Hospital of Jiangsu Province from May 2015 to April 2016. Control group( n = 42) underwent routine open thyroidectomy. Observation group( n = 42) underwent microwave ablation guided by four-dimensional B-ultrasound. Indicators such as intraoperative blood loss,operation time,surgical outcome,postoperative complications were compared between the two groups. Results For observation group,the intraoperative blood loss,operation time,hospitalization days,and scar size [( 2. 36 ± 0. 52) ml,( 36. 93 ± 5. 59) min,( 3. 62 ± 0. 58) d,( 0. 43 ± 0. 08) cm]were lower than control group [( 30. 37 ± 2. 85) ml,( 75. 64 ± 6. 37) min,( 11. 35 ± 1. 27) d,( 3. 25 ± 0. 57) cm]( P < 0. 05). After 24 mo follow-up,the complete ablation rate of nodules for the two groups was 97. 6% and 100%,respectively( P > 0. 05). Nodule size of the observation group before and 3,6 and 12 mo after surgery were( 2. 08 ± 0. 42),( 1. 12 ± 0. 38),( 0. 53 ± 0. 12),( 0. 21 ± 0. 04) cm3( P < 0. 05),nodule size reduction rate being 46. 15%,74. 52% and 89. 90% postoperatively. The incidence of postoperative complications in observation group( 7. 1%) was lower than in control group( 23. 8%)( P < 0. 05). Conclusion Four-dimensional B-ultrasound-guided puncture and microwave ablation is effective in treating nodular goiter regarding blood loss,operation time,postoperative outcome and complications.
Objective To investigate the application of four-dimensional B-ultrasound-guided nodular goiter puncture and microwave ablation. Methods Clinical data were retrospectively analyzed for 84 nodular goiter patients admitted to the Second Hospital of Nanjing and General Hospital of Jiangsu Province from May 2015 to April 2016. Control group( n = 42) underwent routine open thyroidectomy. Observation group( n = 42) underwent microwave ablation guided by four-dimensional B-ultrasound. Indicators such as intraoperative blood loss,operation time,surgical outcome,postoperative complications were compared between the two groups. Results For observation group,the intraoperative blood loss,operation time,hospitalization days,and scar size [( 2. 36 ± 0. 52) ml,( 36. 93 ± 5. 59) min,( 3. 62 ± 0. 58) d,( 0. 43 ± 0. 08) cm]were lower than control group [( 30. 37 ± 2. 85) ml,( 75. 64 ± 6. 37) min,( 11. 35 ± 1. 27) d,( 3. 25 ± 0. 57) cm]( P < 0. 05). After 24 mo follow-up,the complete ablation rate of nodules for the two groups was 97. 6% and 100%,respectively( P > 0. 05). Nodule size of the observation group before and 3,6 and 12 mo after surgery were( 2. 08 ± 0. 42),( 1. 12 ± 0. 38),( 0. 53 ± 0. 12),( 0. 21 ± 0. 04) cm3( P < 0. 05),nodule size reduction rate being 46. 15%,74. 52% and 89. 90% postoperatively. The incidence of postoperative complications in observation group( 7. 1%) was lower than in control group( 23. 8%)( P < 0. 05). Conclusion Four-dimensional B-ultrasound-guided puncture and microwave ablation is effective in treating nodular goiter regarding blood loss,operation time,postoperative outcome and complications.
引文
[1]张定根.B超引导定位穿刺微波消融治疗结节性甲状腺肿的效果分析[J].深圳中西医结合杂志,2017,27(22):78-79.
[2]薛耀明.甲状腺疾病的诊断与治疗[M].北京:人民军医出版社,1995:247-249.
[3]罗顺平,陈杰,戴捷,等.B超引导下甲状腺肿块细针穿刺细胞学诊断的临床病理分析[J].现代生物医学进展,2014,14(2):305-308.
[4]袁冰.外科手术治疗结节性甲状腺肿现状与进展研究[J/CD].临床医药文献电子杂志,2017,4(27):5337.
[5]杨保强.结节性甲状腺肿213例外科治疗体会[J].贵阳中医学院学报,2014,36(1):81-83.
[6]章小华,许年凤.超声引导下穿刺活检在结节性甲状腺肿合并甲状腺癌诊断中的应用价值探究[J].山西医药杂志,2018,47(9):1056-1059.
[7]罗欣,黎兵,徐艳,等.四维超声在膀胱肿瘤良恶性诊断及病理分期中的应用价值研究[J].当代医学,2018,24(9):128-130.
[8]韩艳俊.四维超声在诊断胃及十二指肠占位性疾病中的应用价值[J].中国医药指南,2013,11(9):197-198.
[9]杨进华,刘海波,伍世绩,等.B超引导微波消融与传统手术治疗结节性甲状腺肿临床分析[J].中国综合临床,2016,32(5):417-420.
[10]徐庆玲,于守君,张永林,等.微波消融治疗结节性甲状腺肿对甲状腺功能影响的临床观察[J].介入放射学杂志,2017,26(6):535-538.
[11]李俊韬,夏来阳,黄兴伟,等.B超引导下经皮甲状腺结节穿刺热消融治疗的临床应用[J].中国当代医药,2017,24(36):27-29.
[12]苏力夫,张生彬,朱永蒙.彩色B超引导下射频消融治疗甲状腺良性结节30例报告[J].中国现代医学杂志,2013,23(5):97-100.
[13]时敏,尚海龙,仇纯武,等.超声引导下经皮穿刺微波消融对甲状腺良性结节的疗效[J].江苏医药,2016,42(19):2155-2156.
[14]郭文斌,孔辉,高伟,等.超声引导下射频消融治疗甲状腺良性结节[J].中国普通外科杂志,2012,21(5):634-636.
[2]薛耀明.甲状腺疾病的诊断与治疗[M].北京:人民军医出版社,1995:247-249.
[3]罗顺平,陈杰,戴捷,等.B超引导下甲状腺肿块细针穿刺细胞学诊断的临床病理分析[J].现代生物医学进展,2014,14(2):305-308.
[4]袁冰.外科手术治疗结节性甲状腺肿现状与进展研究[J/CD].临床医药文献电子杂志,2017,4(27):5337.
[5]杨保强.结节性甲状腺肿213例外科治疗体会[J].贵阳中医学院学报,2014,36(1):81-83.
[6]章小华,许年凤.超声引导下穿刺活检在结节性甲状腺肿合并甲状腺癌诊断中的应用价值探究[J].山西医药杂志,2018,47(9):1056-1059.
[7]罗欣,黎兵,徐艳,等.四维超声在膀胱肿瘤良恶性诊断及病理分期中的应用价值研究[J].当代医学,2018,24(9):128-130.
[8]韩艳俊.四维超声在诊断胃及十二指肠占位性疾病中的应用价值[J].中国医药指南,2013,11(9):197-198.
[9]杨进华,刘海波,伍世绩,等.B超引导微波消融与传统手术治疗结节性甲状腺肿临床分析[J].中国综合临床,2016,32(5):417-420.
[10]徐庆玲,于守君,张永林,等.微波消融治疗结节性甲状腺肿对甲状腺功能影响的临床观察[J].介入放射学杂志,2017,26(6):535-538.
[11]李俊韬,夏来阳,黄兴伟,等.B超引导下经皮甲状腺结节穿刺热消融治疗的临床应用[J].中国当代医药,2017,24(36):27-29.
[12]苏力夫,张生彬,朱永蒙.彩色B超引导下射频消融治疗甲状腺良性结节30例报告[J].中国现代医学杂志,2013,23(5):97-100.
[13]时敏,尚海龙,仇纯武,等.超声引导下经皮穿刺微波消融对甲状腺良性结节的疗效[J].江苏医药,2016,42(19):2155-2156.
[14]郭文斌,孔辉,高伟,等.超声引导下射频消融治疗甲状腺良性结节[J].中国普通外科杂志,2012,21(5):634-636.