系统评价体系探讨微波消融术治疗甲状腺良性结节的临床应用价值
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摘要
目的运用系统评价体系探讨微波消融术治疗甲状腺良性结节的临床应用价值。方法回顾性分析2015年5月至2016年2月期间入住皖北煤电集团总医院并行超声引导下微波消融术治疗甲状腺良性结节的50例病人的资料。术后随访6个月,运用系统评价系统从症状(术中)、术后并发症、实验室检测及彩超检查等多方面评估其治疗效果及术后并发症发生情况,进一步客观、全面明确其临床价值。结果所有病人术中不适主诉发生率低,且均可耐受;术后颈部无疤痕;术后并发症少,1周后均明显恢复,未出现永久性后遗症。与术前甲状腺功能相比,术后3 d游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)明显升高,促甲状腺激素(TSH)明显下降,差异有统计学意义;术后1个月FT3、FT4及TSH均与术前相仿,差异无统计学意义。与术前炎症因子相比,术后第一天C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)差异有统计学意义;术后1周,其炎症因子水平均差异无统计学意义。治疗前直径(2. 58±0. 50) cm,结节体积(3. 50±0. 51) cm3;随访6个月后病人的结节直径(0. 65±0. 33) cm,结节体积(0. 37±0. 46) cm3,治疗前后差异有统计学意义(P <0. 05)。病人治疗6月后总有效率达90%,痊愈10%,有效80%,好转10%,失败0%。结论系统评价体系评估超声引导微波消融术治疗甲状腺结节具有创伤小、无疤痕、术后恢复快等优点,具有一定的临床推广意义。
Objective Using the systematic evaluation system to investigate the clinical values of microwave ablation in the treatment of benign thyroid nodules. Methods We retrospective analyzed the clinical data of 50 patients with benign thyroid nodules treated by microwave ablation under the guidance of ultrasound in the Thyroid and Breast Center of our hospital from May-2015 to February-2016.After 6 months' follow-up,evaluation system assessed the therapeutic effection and postoperative complications from the symptoms(intraoperative),postoperative complications,laboratory detections and ultrasound examination,further objectively and comprehensively clarify its clinical values. Results There were low rate of discomfort incidence in all patients,that can be tolerated,with no neck scar.Postoperative complication is low. All patients recoveried in a week. No permanent sequel was found. Compared with the preoperative thyroid function,FT3 and FT4 increased significantly after 3 days,and the TSH decreased significantly. The difference was statistically significant. The FT3,FT4 and TSH were similar to those before surgery,and the difference was not statistically significant. Compared with the preoperative inflammatory factors,there was a statistically significant difference in CRP,IL-6 and TNF-a of the first day postoperative. There was no statistically significant in those factors1 week later. The average diameter of all nodules before treatment is about(2. 58 ± 0. 50) cm,nodule volume(3. 50 ± 0. 51) cm3. After 6 months' follow-up,the average diameter of nodules is about(0. 65 ±0. 33) cm,nodule volume(0. 37 ± 0. 46) cm3. There were statistically significant differences(P < 0. 05). After 6 months,the total effective rate was 90%,and the cured rate,effective rate were 10% was and 80% respectively. 10% were improved and 0% failed. Conclusion Evaluating by systematic evaluation system,ultrasound guided microwave ablation for the treatment of thyroid nodules has the advantages of less trauma,no scar,faster postoperative recovery,with certain clinical significances.
Objective Using the systematic evaluation system to investigate the clinical values of microwave ablation in the treatment of benign thyroid nodules. Methods We retrospective analyzed the clinical data of 50 patients with benign thyroid nodules treated by microwave ablation under the guidance of ultrasound in the Thyroid and Breast Center of our hospital from May-2015 to February-2016.After 6 months' follow-up,evaluation system assessed the therapeutic effection and postoperative complications from the symptoms(intraoperative),postoperative complications,laboratory detections and ultrasound examination,further objectively and comprehensively clarify its clinical values. Results There were low rate of discomfort incidence in all patients,that can be tolerated,with no neck scar.Postoperative complication is low. All patients recoveried in a week. No permanent sequel was found. Compared with the preoperative thyroid function,FT3 and FT4 increased significantly after 3 days,and the TSH decreased significantly. The difference was statistically significant. The FT3,FT4 and TSH were similar to those before surgery,and the difference was not statistically significant. Compared with the preoperative inflammatory factors,there was a statistically significant difference in CRP,IL-6 and TNF-a of the first day postoperative. There was no statistically significant in those factors1 week later. The average diameter of all nodules before treatment is about(2. 58 ± 0. 50) cm,nodule volume(3. 50 ± 0. 51) cm3. After 6 months' follow-up,the average diameter of nodules is about(0. 65 ±0. 33) cm,nodule volume(0. 37 ± 0. 46) cm3. There were statistically significant differences(P < 0. 05). After 6 months,the total effective rate was 90%,and the cured rate,effective rate were 10% was and 80% respectively. 10% were improved and 0% failed. Conclusion Evaluating by systematic evaluation system,ultrasound guided microwave ablation for the treatment of thyroid nodules has the advantages of less trauma,no scar,faster postoperative recovery,with certain clinical significances.
引文
[1]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.
[2]曲明,尹惠生,杨强,等.超声引导下微波消融治疗甲状腺良性结节[J].实用医药杂志,2015,32(6):502-507.
[3]李倩倩,周平.微波、射频及激光在离体猪甲状腺消融实验的对比研究[J].中国普通外科杂志,2016,25(5):675-679.
[4] KLEBE J,HAPPEL C,GRUNWALD F,et al. Visualization of tissue alterations in thyroid nodules after microwave ablation:sonographic versus scintigraphic imaging[J]. Nucl Med Commun,2015,36(3):260-267.
[5]刁宗平.甲状腺腺瘤微波消融及其评价体系的构建与应用[D].第二军医大学,2011.
[6] DAVIES L,WELCH GH. Increasing incidence of thyroid cancer in the United states1973-2002[J]. JAMA,2006,295(18):2164-2167.
[7]王晓明,朱梅菊,刘洋,等.射频消融术治疗57例单发良性甲状腺结节的临床应用[J].中国实用医药,2015,10(13):111-112.
[8]杨映弘,吴晓莉,颜璟,等.超声引导下微波消融治疗甲状腺良性结节37例报告[J].中国微创外科杂志,2016,16(4):313-316.
[9]杨雪丰,陈建发,冯蕊,等.超声引导下经皮微波消融术治疗甲状腺良性结节55例临床分析[J].广东医学院学报. 2016,34(2):169-172.
[10]王龙琦,陈坚,刘绪舜.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[J].中国微创外科杂志,2016,16(3):236-240.
[11]孔月,程志刚,韩治宇,等.移动消融技术在微波消融治疗甲状腺良性结节中的应用价值[J].解放军医学院学报,2014,35(7):660-662,691.
[12]章建全,盛建国,刁宗平,等.液体隔离法在颈部结节性病变经皮热消融治疗中的应用[J].第二军医大学学报,2014,35(10):1045-1052.
[13] BEAK JH,KIM YS,LEE D,et al. Benign predominantly solid thyroid nodules prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition[J]. AJR Am J Roentgenol. 2010,194(4):1137-1142.
[14] HECK K,HAPPEL C,GRUNWALD F,et al. Percutaneous microwave ablation of thyroid nodules:effects on thyroid function and antibodies[J]. Int J Hyperthermia,2015,31(5):560-567.
[15]王丽森,田力升,程建中,等.经皮微波消融甲状腺结节的临床效果[J].实用中西医结合临床,2017,17(4):66-67.
[16] KORKUSUZ H,HAPPEL C,HECK K,et al. Percutaneous thermal microwave ablation of thyroid nodules. Preparation,feasibility,efficiency.[J]. Nuklearmedizin,2014,53(4):123-130.
[2]曲明,尹惠生,杨强,等.超声引导下微波消融治疗甲状腺良性结节[J].实用医药杂志,2015,32(6):502-507.
[3]李倩倩,周平.微波、射频及激光在离体猪甲状腺消融实验的对比研究[J].中国普通外科杂志,2016,25(5):675-679.
[4] KLEBE J,HAPPEL C,GRUNWALD F,et al. Visualization of tissue alterations in thyroid nodules after microwave ablation:sonographic versus scintigraphic imaging[J]. Nucl Med Commun,2015,36(3):260-267.
[5]刁宗平.甲状腺腺瘤微波消融及其评价体系的构建与应用[D].第二军医大学,2011.
[6] DAVIES L,WELCH GH. Increasing incidence of thyroid cancer in the United states1973-2002[J]. JAMA,2006,295(18):2164-2167.
[7]王晓明,朱梅菊,刘洋,等.射频消融术治疗57例单发良性甲状腺结节的临床应用[J].中国实用医药,2015,10(13):111-112.
[8]杨映弘,吴晓莉,颜璟,等.超声引导下微波消融治疗甲状腺良性结节37例报告[J].中国微创外科杂志,2016,16(4):313-316.
[9]杨雪丰,陈建发,冯蕊,等.超声引导下经皮微波消融术治疗甲状腺良性结节55例临床分析[J].广东医学院学报. 2016,34(2):169-172.
[10]王龙琦,陈坚,刘绪舜.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[J].中国微创外科杂志,2016,16(3):236-240.
[11]孔月,程志刚,韩治宇,等.移动消融技术在微波消融治疗甲状腺良性结节中的应用价值[J].解放军医学院学报,2014,35(7):660-662,691.
[12]章建全,盛建国,刁宗平,等.液体隔离法在颈部结节性病变经皮热消融治疗中的应用[J].第二军医大学学报,2014,35(10):1045-1052.
[13] BEAK JH,KIM YS,LEE D,et al. Benign predominantly solid thyroid nodules prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition[J]. AJR Am J Roentgenol. 2010,194(4):1137-1142.
[14] HECK K,HAPPEL C,GRUNWALD F,et al. Percutaneous microwave ablation of thyroid nodules:effects on thyroid function and antibodies[J]. Int J Hyperthermia,2015,31(5):560-567.
[15]王丽森,田力升,程建中,等.经皮微波消融甲状腺结节的临床效果[J].实用中西医结合临床,2017,17(4):66-67.
[16] KORKUSUZ H,HAPPEL C,HECK K,et al. Percutaneous thermal microwave ablation of thyroid nodules. Preparation,feasibility,efficiency.[J]. Nuklearmedizin,2014,53(4):123-130.