超声引导下微波消融治疗甲状腺微小乳头状癌
|
摘要
目的探讨超声引导下微波消融术治疗甲状腺微小乳头状癌的临床效果。方法超声引导下细针穿刺活检确诊为甲状腺微小乳头状癌且彩超提示颈部无可疑转移淋巴结的20例患者,行超声引导下微波消融术。术后1个月复查甲状腺功能指标并记录并发症发生情况。术后1、3、6、12、18、24个月随访观察结节缩小、吸收情况,有无结节复发及颈部淋巴结转移情况。结果术后1个月复查甲状腺功能指标与术前比较差异有统计学意义。术后出现声音嘶哑1例,3个月后自行恢复正常,6例感咽部不适,给予雾化吸入数日后恢复正常。术后1、3、6个月甲状腺结节体积缩小率分别为57.8%、42.6%、80.5%。其中8例消融灶于术后12个月完全吸收,12例于术后18个月完全吸收。随访过程中未发现结节复发及颈部淋巴结转移。结论超声引导下微波消融术治疗甲状腺微小乳头状癌,为拒绝手术患者提供了一种新型微创治疗方法。其术后并发症少,甲状腺功能影响小,安全性高。
Objective To investigate the clinical effect of ultrasound-guided microwave ablation in the treatment of thyroid micropapillary carcinoma. Methods Ultrasound-guided fine needle biopsy confirmed 20 patients with micropapillary thyroid carcinoma and color Doppler ultrasonography showed above finding without suspected metastatic lymph nodes,thus ultrasound guided microwave ablation was performed on them. Thyroid function index and complications were reexamined and recorded 1 month after operation;then nodule reduced and absorpted whether has the nodule recurrence and the neck lymph node metastasis situation were observed after1,3,6,12,18 and 24 months follow-up. Results There was significant difference in thyroid function index compared with that before surgery 1 month after operation.Postoperative hoarseness occurred in 1 case,back to normal 3 months later,6 cases of pharynx discomfort,the aerosol inhalation was given back to normal after a few days. The reduction rate of thyroid nodule volume was 57.8%,42.6%,80.5%,respectively at 1,3 and6 months after operation;of them 8 were completely absorbed at 12 months postoperatively,12 cases were completely absorbed at18 months after operation. Nodule recurrence and cervical lymph node metastasis were not found during followup. Conclusion Ultrasound-guided microwave ablation in the treatment of thyroid micropapillary carcinoma as a new type of minimally invasive treatment is provided for the patients who refuse surgery. It has less postoperative complications,less influence on thyroid function,and its safety is high.
Objective To investigate the clinical effect of ultrasound-guided microwave ablation in the treatment of thyroid micropapillary carcinoma. Methods Ultrasound-guided fine needle biopsy confirmed 20 patients with micropapillary thyroid carcinoma and color Doppler ultrasonography showed above finding without suspected metastatic lymph nodes,thus ultrasound guided microwave ablation was performed on them. Thyroid function index and complications were reexamined and recorded 1 month after operation;then nodule reduced and absorpted whether has the nodule recurrence and the neck lymph node metastasis situation were observed after1,3,6,12,18 and 24 months follow-up. Results There was significant difference in thyroid function index compared with that before surgery 1 month after operation.Postoperative hoarseness occurred in 1 case,back to normal 3 months later,6 cases of pharynx discomfort,the aerosol inhalation was given back to normal after a few days. The reduction rate of thyroid nodule volume was 57.8%,42.6%,80.5%,respectively at 1,3 and6 months after operation;of them 8 were completely absorbed at 12 months postoperatively,12 cases were completely absorbed at18 months after operation. Nodule recurrence and cervical lymph node metastasis were not found during followup. Conclusion Ultrasound-guided microwave ablation in the treatment of thyroid micropapillary carcinoma as a new type of minimally invasive treatment is provided for the patients who refuse surgery. It has less postoperative complications,less influence on thyroid function,and its safety is high.
引文
[1]AIOUI Medicine,ACO Radiology.AIUM practice guideline for the perfomance of a thyroid and parathyroid ultrasound examination[J].J Ultrasound Med:official J American Institute of Ultrasound in Med,2013,32(7):1319-1329.
[2]LEW JI,SOLORZANO CC.Use of ultrasound in the magagement of thyroid cancer[J].Oncologist,2010,15(3):253-258.
[3].RUSS G,LEBOULLEUX S,LEENHARDT L,et al.Thyroid incidentalomas:epidemiology,risk stratification with ultrasound and workup[J].European thyroid journal,2014,3(3):154-163.
[4]倪晓枫,詹维伟,宋琳琳,等.超声引导下细针穿刺抽吸活检不同大小甲状腺结节的价值[J].中国介入影像与治疗学,2013,10(8):461-464.
[5]ITO Y,MASUOKA H,FUKUSHIMA M,et al.Excellent prognosis of patients with solitary T1N0M0 papillary thyroid carcinoma who underwent thyroidectomy and elective lymph node dissection without radioiodine therapy[J].World J Surg,2010,34(6):1285-1290.
[6]姜雪峰,吴凤林,纪莉,等.射频消融高风险甲状腺结节避免喉返神经损伤的方法探讨[J].中国超声医学杂志,2014,30(7):577-580.
[7]PACELLA CM,BIZZARRI G,SPIEZIA S,et al.Thyroid tissue:US-guided percutaneous laser thermal ablation[J].Radiology,2004,232(1):272-280.
[8]PAPINI E,GUGLIELMI R,GHARIB H,et al.Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma:a potential therapeutic approach in patients at surgicalrisk[J].Thyroid,2011,21(8):917-920.
[9]浙江省抗癌协会甲状腺肿瘤专业委员会.甲状腺良性结节、微小癌及颈部转移性淋巴结热消融(射频、微波、激光)治疗专家共识(2015版)[J].中国普通外科杂志,2016,25(7):944-946.
[10]于洋,高明.甲状腺微小乳头状癌外科治疗进展[J].中国肿瘤临床,2015,42(9):487-490.
[11]ITO Y,MIYAUCHI A,INOUE H,et al.An observational trial for papillary thyroid microcarcinoma in Japanese patients[J].World J Surg,2010,34(1):28-35.
[12]ITO Y,MIYAUCHI A,KIHARA M,et al.Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation[J].Thyroid,2014,24(1):27-34.
[13]PELLEGRITI G,SCOLLO C,LUMERA G,et al.Clinical behavior and outcome of papillary thyroid cancers smaller than1.5cm in diameter:study of 299 cases[J].J Clin Endocrinol Metab,2004,89(8):3713-3720.
[14]王淑荣,岳雯雯,张永林,等.超声引导下经皮微波消融治疗甲状腺良性结节的疗效观察[J].中华超声影像学杂志,2015,8(24):675-679.
[15]CHO BY,CHOI HS,PARK YJ,et al.Changes in the clinicopathological characteristics and outcomes of thyroid cancer in Korea over the past four decades[J].Thyroid,2013,23(7):797-804
[16]BRITO JP,GIONFRIDDO MR,AL NA,et al.The accuracy of thyroid nodule ultrasound to predict thyroid cancer:systematic review and meta-analysis[J].J Clin Endocrinol Metab,2014,99(4):1253-1263.
[17]TRIMBOLI P,GUGLIELMI R,MONTI S,et al.Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography:a prospective multicenter study[J].J Clin Endocrinol Metab,2012,97(12):4524-4530.
[18]赵敬柱,高明,张晟,等.B超介导甲状腺微小乳头状癌定性及定位诊断价值研究[J].中国实用外科杂志,2013,33(5):393-396.
[2]LEW JI,SOLORZANO CC.Use of ultrasound in the magagement of thyroid cancer[J].Oncologist,2010,15(3):253-258.
[3].RUSS G,LEBOULLEUX S,LEENHARDT L,et al.Thyroid incidentalomas:epidemiology,risk stratification with ultrasound and workup[J].European thyroid journal,2014,3(3):154-163.
[4]倪晓枫,詹维伟,宋琳琳,等.超声引导下细针穿刺抽吸活检不同大小甲状腺结节的价值[J].中国介入影像与治疗学,2013,10(8):461-464.
[5]ITO Y,MASUOKA H,FUKUSHIMA M,et al.Excellent prognosis of patients with solitary T1N0M0 papillary thyroid carcinoma who underwent thyroidectomy and elective lymph node dissection without radioiodine therapy[J].World J Surg,2010,34(6):1285-1290.
[6]姜雪峰,吴凤林,纪莉,等.射频消融高风险甲状腺结节避免喉返神经损伤的方法探讨[J].中国超声医学杂志,2014,30(7):577-580.
[7]PACELLA CM,BIZZARRI G,SPIEZIA S,et al.Thyroid tissue:US-guided percutaneous laser thermal ablation[J].Radiology,2004,232(1):272-280.
[8]PAPINI E,GUGLIELMI R,GHARIB H,et al.Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma:a potential therapeutic approach in patients at surgicalrisk[J].Thyroid,2011,21(8):917-920.
[9]浙江省抗癌协会甲状腺肿瘤专业委员会.甲状腺良性结节、微小癌及颈部转移性淋巴结热消融(射频、微波、激光)治疗专家共识(2015版)[J].中国普通外科杂志,2016,25(7):944-946.
[10]于洋,高明.甲状腺微小乳头状癌外科治疗进展[J].中国肿瘤临床,2015,42(9):487-490.
[11]ITO Y,MIYAUCHI A,INOUE H,et al.An observational trial for papillary thyroid microcarcinoma in Japanese patients[J].World J Surg,2010,34(1):28-35.
[12]ITO Y,MIYAUCHI A,KIHARA M,et al.Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation[J].Thyroid,2014,24(1):27-34.
[13]PELLEGRITI G,SCOLLO C,LUMERA G,et al.Clinical behavior and outcome of papillary thyroid cancers smaller than1.5cm in diameter:study of 299 cases[J].J Clin Endocrinol Metab,2004,89(8):3713-3720.
[14]王淑荣,岳雯雯,张永林,等.超声引导下经皮微波消融治疗甲状腺良性结节的疗效观察[J].中华超声影像学杂志,2015,8(24):675-679.
[15]CHO BY,CHOI HS,PARK YJ,et al.Changes in the clinicopathological characteristics and outcomes of thyroid cancer in Korea over the past four decades[J].Thyroid,2013,23(7):797-804
[16]BRITO JP,GIONFRIDDO MR,AL NA,et al.The accuracy of thyroid nodule ultrasound to predict thyroid cancer:systematic review and meta-analysis[J].J Clin Endocrinol Metab,2014,99(4):1253-1263.
[17]TRIMBOLI P,GUGLIELMI R,MONTI S,et al.Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography:a prospective multicenter study[J].J Clin Endocrinol Metab,2012,97(12):4524-4530.
[18]赵敬柱,高明,张晟,等.B超介导甲状腺微小乳头状癌定性及定位诊断价值研究[J].中国实用外科杂志,2013,33(5):393-396.