超声引导下射频消融治疗甲状腺乳头状癌颈部转移淋巴结的价值研究
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摘要
目的探讨超声引导下射频消融治疗甲状腺乳头状癌颈部转移淋巴结的临床价值。方法选择我院收治的甲状腺乳头状癌颈部转移淋巴结患者82例,共202枚转移淋巴结,入院后接受超声引导下射频消融治疗,检测治疗前及治疗后1、3、6个月疗效与血清甲状腺球蛋白水平。结果 202枚转移淋巴结均成功消融,其中186枚使用功率为3 W,16枚为5 W;消融时间23～482s,平均(155.4±88.6)s,总能量75～1 460J,平均为(442.5±276.3)J。所有患者的手术均顺利进行,未发生严重并发症。所有患者超声引导下射频消融术治疗后1、3、6个月,血清甲状腺球蛋白水平均较治疗前降低,差异有统计学意义(P<0.05)。所有患者超声引导下射频消融术治疗后1、3、6个月,转移淋巴结体积均较治疗前缩小,差异有统计学意义(P<0.05),且治疗后6个月缩小程度高于治疗后1、3个月,差异有统计学意义(P<0.05)。结论超声引导下射频消融治疗甲状腺乳头状癌颈部转移淋巴结,可有效降低患者血清甲状腺球蛋白水平、缩小转移淋巴结体积,安全性较高,疗效显著。
Objective To investigate the feasibility,efficacy and safety of ultrasound-guided radiofrequency ablation for cervical metastatic lymph nodes of papillary thyroid carcinoma.Methods 82 patients with thyroid papillary carcinoma with cervical lymph node metastasis were selected.All patients were treated with ultrasound-guided radiofrequency ablation.The therapeutic effects and serum thyroglobulin levels were measured before and after treatment for 1 month,3 months and 6 months.Results All 202 metastatic lymph nodes were ablated successfully,186 of which were ablated at a power of 3 Wand 16 at a power of 5 W,the ablation time was 23-482 s,the average ablation time was(155.4±88.6)s,the total energy was 75-1460 J,and the average total energy was(442.5±276.3)J.All patients performed smoothly without serious complications.The levels of serum thyroglobulin were significantly decreased in all patients after ultrasound-guided radiofrequency ablation 1 month,3 months and 6 months(P<0.05).The volume of metastatic lymph nodes was significantly smaller in all patients after ultrasound-guided radiofrequency ablation 1 month,3 months and 6 months than before(P<0.05),and the reduction degree in 6 months was higher than that in 1 month and 3 months after treatment(P<0.05).Conclusions Ultrasound-guided radiofrequency ablation for cervical metastatic lymph nodes of papillary thyroid carcinoma can effectively improve the level of serum thyroglobulin and reduce the volume of metastatic lymph nodes.
Objective To investigate the feasibility,efficacy and safety of ultrasound-guided radiofrequency ablation for cervical metastatic lymph nodes of papillary thyroid carcinoma.Methods 82 patients with thyroid papillary carcinoma with cervical lymph node metastasis were selected.All patients were treated with ultrasound-guided radiofrequency ablation.The therapeutic effects and serum thyroglobulin levels were measured before and after treatment for 1 month,3 months and 6 months.Results All 202 metastatic lymph nodes were ablated successfully,186 of which were ablated at a power of 3 Wand 16 at a power of 5 W,the ablation time was 23-482 s,the average ablation time was(155.4±88.6)s,the total energy was 75-1460 J,and the average total energy was(442.5±276.3)J.All patients performed smoothly without serious complications.The levels of serum thyroglobulin were significantly decreased in all patients after ultrasound-guided radiofrequency ablation 1 month,3 months and 6 months(P<0.05).The volume of metastatic lymph nodes was significantly smaller in all patients after ultrasound-guided radiofrequency ablation 1 month,3 months and 6 months than before(P<0.05),and the reduction degree in 6 months was higher than that in 1 month and 3 months after treatment(P<0.05).Conclusions Ultrasound-guided radiofrequency ablation for cervical metastatic lymph nodes of papillary thyroid carcinoma can effectively improve the level of serum thyroglobulin and reduce the volume of metastatic lymph nodes.
引文
[1]刘洁,胡如英,张琼敏,等.甲状腺乳头状癌术后超声引导下淋巴结穿刺195例的临床分析[J].医学影像学杂志,2016,26(10):1799-1802.
[2]寿金朵,蒋贤锋,朱江,等.术前超声引导淋巴结细针穿刺检查联合洗脱液甲状腺球蛋白测定对诊断甲状腺乳头状癌侧颈部淋巴结转移的价值[J].中华普通外科杂志,2016,31(12):989-992.
[3]中华医学会内分泌学分会.甲状腺结节和分化型甲状腺癌诊治指南[J].中华核医学与分子影像杂志,2013,33(2):96-115.
[4]李建如,罗渝昆,李岩密,等.超声引导下射频消融治疗甲状腺微小乳头状癌的疗效分析[J].解放军医学院学报,2016,37(8):823-826.
[5]刘雪平,黄继光,周余旺,等.超声引导下微小乳头状癌射频消融临床应用[J].医学影像学杂志,2016,26(11):1970-1973.
[6] GIRARDI F M,BARRA M B,ZETTLER C G,et al.Analysis of pattern of occurrence of thyroid carcinoma between 2001and2010[J].Braz J Otorhinolaryngol,2015,7(7):219-225.
[7] LUPO M A.Radiofrequency ablation for benign thyroid nodules-a look towards the future of interventional thyroidology[J].Endocr Pract,2015,21(8):972-974.
[8] ELGAZZAR A H,ALENEZI S,ALSHAMMARI J M,et al.Value of Oblique View in Nodular Thyroid Disease;Revisiting Fundamentals[J].World J Nucl Med,2015,14(2):125-127.
[9]朱梅菊,卢秀波,刘洋,等.甲状腺乳头状癌术后并发症分析[J].中国实用医刊,2015,42(7):10-11.
[10]彭湃,陈周浔,王鹏飞,等.完全腔镜下甲状腺癌手术15例[J].中华普通外科杂志,2015,30(4):323-324.
[11]王敬东,滕晓铭.腔镜辅助下甲状腺切除术疗效的Meta分析[J].中国医药指南,2015,13(13):183.
[12]陈敏华.影像指导肝癌射频消融规范化治疗[J].中华医学杂志,2015,95(27):2129-2132.
[13]曾川,张献全.肺癌的射频消融治疗现状及进展[J].中华肺部疾病杂志,2015,8(2):99-101.
[14]刘池拽,邓建伟,师天雄.射频消融技术在甲状腺疾病中的临床进展[J/OL].中华普通外科学文献:电子版,2015,9(3):238-241.
[15]杨静洲,黄道中,宋海英.甲状腺微小癌的高频超声和弹性成像声像图特征及误诊原因分析[J].中华超声影像学杂志,2015,24(1):28-31.
[16]隋洋,吴凤林,孙医学.超声引导下射频消融甲状腺结节的并发症与预防方法探讨[J].医学影像学杂志,2014,24(1):32-35.
[17]章建全.经皮热消融治疗在甲状腺乳头状癌及其区域淋巴结转移中的应用前景[J/OL].中华医学超声杂志:电子版,2014,11(8):1-4.
[2]寿金朵,蒋贤锋,朱江,等.术前超声引导淋巴结细针穿刺检查联合洗脱液甲状腺球蛋白测定对诊断甲状腺乳头状癌侧颈部淋巴结转移的价值[J].中华普通外科杂志,2016,31(12):989-992.
[3]中华医学会内分泌学分会.甲状腺结节和分化型甲状腺癌诊治指南[J].中华核医学与分子影像杂志,2013,33(2):96-115.
[4]李建如,罗渝昆,李岩密,等.超声引导下射频消融治疗甲状腺微小乳头状癌的疗效分析[J].解放军医学院学报,2016,37(8):823-826.
[5]刘雪平,黄继光,周余旺,等.超声引导下微小乳头状癌射频消融临床应用[J].医学影像学杂志,2016,26(11):1970-1973.
[6] GIRARDI F M,BARRA M B,ZETTLER C G,et al.Analysis of pattern of occurrence of thyroid carcinoma between 2001and2010[J].Braz J Otorhinolaryngol,2015,7(7):219-225.
[7] LUPO M A.Radiofrequency ablation for benign thyroid nodules-a look towards the future of interventional thyroidology[J].Endocr Pract,2015,21(8):972-974.
[8] ELGAZZAR A H,ALENEZI S,ALSHAMMARI J M,et al.Value of Oblique View in Nodular Thyroid Disease;Revisiting Fundamentals[J].World J Nucl Med,2015,14(2):125-127.
[9]朱梅菊,卢秀波,刘洋,等.甲状腺乳头状癌术后并发症分析[J].中国实用医刊,2015,42(7):10-11.
[10]彭湃,陈周浔,王鹏飞,等.完全腔镜下甲状腺癌手术15例[J].中华普通外科杂志,2015,30(4):323-324.
[11]王敬东,滕晓铭.腔镜辅助下甲状腺切除术疗效的Meta分析[J].中国医药指南,2015,13(13):183.
[12]陈敏华.影像指导肝癌射频消融规范化治疗[J].中华医学杂志,2015,95(27):2129-2132.
[13]曾川,张献全.肺癌的射频消融治疗现状及进展[J].中华肺部疾病杂志,2015,8(2):99-101.
[14]刘池拽,邓建伟,师天雄.射频消融技术在甲状腺疾病中的临床进展[J/OL].中华普通外科学文献:电子版,2015,9(3):238-241.
[15]杨静洲,黄道中,宋海英.甲状腺微小癌的高频超声和弹性成像声像图特征及误诊原因分析[J].中华超声影像学杂志,2015,24(1):28-31.
[16]隋洋,吴凤林,孙医学.超声引导下射频消融甲状腺结节的并发症与预防方法探讨[J].医学影像学杂志,2014,24(1):32-35.
[17]章建全.经皮热消融治疗在甲状腺乳头状癌及其区域淋巴结转移中的应用前景[J/OL].中华医学超声杂志:电子版,2014,11(8):1-4.