经峡部和经侧颈部路径微波消融甲状腺内后象限结节的比较
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摘要
目的:比较超声引导下经峡部和经侧颈部路径微波消融甲状腺内后象限良性结节的临床效果。方法:回顾性分析超声引导下微波消融甲状腺内后象限良性结节142枚,其中,经峡部组83枚,经侧颈部组59枚,比较两组消融手术的麻醉剂用量、隔离带液体用量、治疗时间、术中疼痛评分、术后并发症、术后症状评分、美容评分、治疗成功率及结节体积缩小率等指标。结果:两组患者治疗过程中麻醉剂用量,隔离带液体用量,治疗时间,术中疼痛评分,术后并发症,术后1、3、6、12个月症状评分,美容评分,术后1、3个月结节体积缩小率及治疗成功率等差异均无统计学意义(P> 0. 05)。但经侧颈部组术后6、12个月结节体积缩小率均明显大于经峡部组(P <0. 05)。结论:对于甲状腺内后象限良性结节可以考虑经侧颈部进针路径进行微波消融治疗。
Objective: To compare the clinical efficacy of the trans-isthmic approach and the lateral cervical approach for ultrasound-guided microwave ablation in treatment of benign thyroid nodules located in the lower-inner quadrant. Methods: A total of 142 benign thyroid nodules located in the lower-inner quadrant treated with ultrasound-guided microwave ablation were retrospectively analyzed,including 83 nodules ablated by trans-isthmic approach and 59 ablated by lateral cervical approach. The volume of 2%lidocaine,the volume of liquid isolating region,the ablation time,intraoperative pain score,complications,symptom score,cosmetic score,therapeutic success rates,and nodule volume reduction ratios were compared between the two groups. Results: Between the two groups,no significant differences were found in the volume of 2% lidocaine,the volume of liquid isolating region,the ablation time,intraoperative pain score,and the complications occurred after treatment,as well as the symptom scores,cosmetic scores,and therapeutic success rates at 1,3,6,12 months( P > 0. 05) after treatment. No significant differences were found in nodule volume reduction ratios end points at 1,3 months( P > 0. 05) after treatment. However,at 6,12 months( P < 0. 05) after treatment,the volume reduction ratios of the lateral cervical approach group were higher than those of the trans-isthmic approach group. Conclusion: For be-nign nodules located in the lower-inner quadrant,the lateral cervical approach for ultrasound-guided microwave ablation can be considered.
Objective: To compare the clinical efficacy of the trans-isthmic approach and the lateral cervical approach for ultrasound-guided microwave ablation in treatment of benign thyroid nodules located in the lower-inner quadrant. Methods: A total of 142 benign thyroid nodules located in the lower-inner quadrant treated with ultrasound-guided microwave ablation were retrospectively analyzed,including 83 nodules ablated by trans-isthmic approach and 59 ablated by lateral cervical approach. The volume of 2%lidocaine,the volume of liquid isolating region,the ablation time,intraoperative pain score,complications,symptom score,cosmetic score,therapeutic success rates,and nodule volume reduction ratios were compared between the two groups. Results: Between the two groups,no significant differences were found in the volume of 2% lidocaine,the volume of liquid isolating region,the ablation time,intraoperative pain score,and the complications occurred after treatment,as well as the symptom scores,cosmetic scores,and therapeutic success rates at 1,3,6,12 months( P > 0. 05) after treatment. No significant differences were found in nodule volume reduction ratios end points at 1,3 months( P > 0. 05) after treatment. However,at 6,12 months( P < 0. 05) after treatment,the volume reduction ratios of the lateral cervical approach group were higher than those of the trans-isthmic approach group. Conclusion: For be-nign nodules located in the lower-inner quadrant,the lateral cervical approach for ultrasound-guided microwave ablation can be considered.
引文
[1]Kim JH,Baek JH,Lim HK,et al.2017 thyroid radiofrequency ablation guideline:Korean society of thyroid radiology[J].Korean J Radiol,2018,19(4):632-655.
[2]中国医师协会甲状腺肿瘤治疗技术专家组,中国抗癌协会甲状腺癌专业委员会,中国医师协会介入医师分会超声介入专业委员会,等.甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识(2018版)[J].中国肿瘤,2018,27(10):768-773.
[3]Shin JH,Baek JH,Ha EJ,et al.Radiofrequency ablation of thyroid nodules:basic principles and clinical application[J].Int J Endocrinol,2012,2012:919650.
[4]Baek JH,Lee JH,Valcavi R,et al.Thermal ablation for benign thyroid nodules:radiofrequency and laser[J].Korean J Radiol,2011,12(5):525-540.
[5]Lim HK,Lee JH,Ha EJ,et al.Radiofrequency ablation of benign non-functioning thyroid nodules:4-year follow-up results for 111 patients[J].Eur Radiol,2012,23(4):1044-1049.
[6]Sung JY,Kim YS,Choi H,et al.Optimum first-line treatment technique for benign cystic thyroid nodules:ethanol ablation or radiofrequency ablation[J].AJR Am J Roentgenol,2011,196(2):W210-W214.
[7]Wasner GL,Brock JA.Determinants of thermal pain thresholds in normal subjects[J].Clin Neurophysiol,2008,119(10):2389-2395.
[8]Yue WW,Wang SR,Wang B,et al.Ultrasound guided percutaneous microwave ablation of benign thyroid nodules:safety and imaging follow-up in 222 patients[J].Eur J Radiol,2013,82(1):e11-e16.
[9]Jeong WK,Baek JH,Rhim H,et al.Radiofrequency ablation of benign thyroid nodules:safety and imaging follow-up in 236 patients[J].Eur Radiol,2008,18(6):1244-1250.
[10]Baek JH,Jeong HJ,Kim YS.Radiofrequency ablation for an autonomously functioning thyroid nodule[J].Thyroid,2008,18(6):675-676.
[11]Yue WW,Wang SR,Lu F,et al.Radiofrequency ablation vs microwave ablation for patients with benign thyroid nodules:a propensity score matching study[J].Endocrine,2017,55(2):485-495.
[12]Dssing H,Bennedbk FN,Hegedüs L.Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules[J].Eur J Endocrinol,2011,165(1):123-128.
[13]Wang B,Han ZY,Yu J,et al.Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation[J].Int J Hyperthermia,2017,33(4):459-464.
[2]中国医师协会甲状腺肿瘤治疗技术专家组,中国抗癌协会甲状腺癌专业委员会,中国医师协会介入医师分会超声介入专业委员会,等.甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识(2018版)[J].中国肿瘤,2018,27(10):768-773.
[3]Shin JH,Baek JH,Ha EJ,et al.Radiofrequency ablation of thyroid nodules:basic principles and clinical application[J].Int J Endocrinol,2012,2012:919650.
[4]Baek JH,Lee JH,Valcavi R,et al.Thermal ablation for benign thyroid nodules:radiofrequency and laser[J].Korean J Radiol,2011,12(5):525-540.
[5]Lim HK,Lee JH,Ha EJ,et al.Radiofrequency ablation of benign non-functioning thyroid nodules:4-year follow-up results for 111 patients[J].Eur Radiol,2012,23(4):1044-1049.
[6]Sung JY,Kim YS,Choi H,et al.Optimum first-line treatment technique for benign cystic thyroid nodules:ethanol ablation or radiofrequency ablation[J].AJR Am J Roentgenol,2011,196(2):W210-W214.
[7]Wasner GL,Brock JA.Determinants of thermal pain thresholds in normal subjects[J].Clin Neurophysiol,2008,119(10):2389-2395.
[8]Yue WW,Wang SR,Wang B,et al.Ultrasound guided percutaneous microwave ablation of benign thyroid nodules:safety and imaging follow-up in 222 patients[J].Eur J Radiol,2013,82(1):e11-e16.
[9]Jeong WK,Baek JH,Rhim H,et al.Radiofrequency ablation of benign thyroid nodules:safety and imaging follow-up in 236 patients[J].Eur Radiol,2008,18(6):1244-1250.
[10]Baek JH,Jeong HJ,Kim YS.Radiofrequency ablation for an autonomously functioning thyroid nodule[J].Thyroid,2008,18(6):675-676.
[11]Yue WW,Wang SR,Lu F,et al.Radiofrequency ablation vs microwave ablation for patients with benign thyroid nodules:a propensity score matching study[J].Endocrine,2017,55(2):485-495.
[12]Dssing H,Bennedbk FN,Hegedüs L.Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules[J].Eur J Endocrinol,2011,165(1):123-128.
[13]Wang B,Han ZY,Yu J,et al.Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation[J].Int J Hyperthermia,2017,33(4):459-464.
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