本文選題：豬甲狀腺 + 激光消融　； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：探討在超聲引導(dǎo)下不同功率及不同能量作用下激光消融離體豬甲狀腺組織的消融形態(tài)、范圍、溫升曲線等參數(shù),評估其有效性、安全性及可行性,確定消融甲狀腺組織的最佳功率及總能量,為激光消融甲狀腺結(jié)節(jié)的臨床應(yīng)用提供參考。 材料與方法：采用意大利百勝醫(yī)療ECHO LASER集成激光介入超聲系統(tǒng)。在超聲引導(dǎo)下對新鮮離體豬甲狀腺采用不同能量組合進(jìn)行激光消融,消融功率分別采用1W、2W、3W、4W、5W、6W、7W,能量為300J、600J、900J、1200J、1500J、1800J、消融的同時采用熱電偶在距離光纖Omm、5mm、10mm及15mm處進(jìn)行實時測溫。消融術(shù)后對消融組織做病理學(xué)檢查證實消融效果,并對各組的消融情況進(jìn)行比較。 結(jié)果：消融區(qū)域大致呈橢圓形,超聲表現(xiàn)為中央強(qiáng)回聲區(qū),周邊稍強(qiáng)回聲區(qū),后方回聲可見衰減。切開后,肉眼觀察消融區(qū)域中央為碎渣樣碳化包繞的空腔,周邊為灰白色或淺黃色壞死組織。HE染色顯示：消融區(qū)中央呈規(guī)則的類橢圓形的空洞區(qū),幾乎無染色劑浸染,周邊可見一層較薄的碳化層,最外圍為壞死的甲狀腺濾泡。光鏡下顯示：中央呈“空洞狀”,周邊甲狀腺組織濾泡減少,濾泡上皮收縮,上皮細(xì)胞核明顯固縮。溫度顯示：功率≥2W各組光纖中心及距離光纖5mm處溫度均超過60℃。統(tǒng)計學(xué)結(jié)果得出：功率3W、能量為1200-1800J,消融范圍差異有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：超聲引導(dǎo)下激光消融離體正常豬甲狀腺組織安全性高、效果明確、消融范圍穩(wěn)定；消融范圍隨著功率及能量的增加而增加,本實驗得出功率為3W,能量為1200-1800J時,可獲得最佳消融效果。圖8幅,表2個,參考文獻(xiàn)28篇。 背景：激光消融是近年來發(fā)展起來的一種微創(chuàng)治療方法,目前已有不少關(guān)于激光消融的文獻(xiàn)報道,但鮮有關(guān)于甲狀腺結(jié)節(jié)激光消融根治治療的文獻(xiàn)報道。 目的：通過超聲引導(dǎo)下激光消融甲狀腺良性結(jié)節(jié),探討超聲引導(dǎo)下經(jīng)皮激光消融治療甲狀腺良性結(jié)節(jié)的可行性、安全性及臨床價值。 方法：2012年9月到2014年4月間在我院行超聲引導(dǎo)下激光消融治療甲狀腺良性結(jié)節(jié)的患者共90例118個病灶。術(shù)前常規(guī)檢查甲狀腺功能并評估臨床癥狀,并采用常規(guī)超聲及超聲造影評估所有甲狀腺結(jié)節(jié)的大小及增強(qiáng)情況。消融功率設(shè)置為3W。消融方法根據(jù)結(jié)節(jié)大小決定采取單針、多針或多點消融。術(shù)后1天進(jìn)行超聲造影評估結(jié)節(jié)的完全消融情況。術(shù)后1,3,6,12,18個月的隨訪期進(jìn)行甲狀腺結(jié)節(jié)體積、甲狀腺功能、臨床癥狀及并發(fā)癥等的評估。本研究經(jīng)我院倫理委員會批準(zhǔn),所有患者均獲得了知情同意并簽署書面知情同意書。 結(jié)果：所有甲狀腺良性結(jié)節(jié)均成功進(jìn)行了消融治療。其中結(jié)節(jié)的最大長徑≤1cm的結(jié)節(jié)一次性消融率為97.1%,≤2cm的結(jié)節(jié)一次性消融率為91.2%,2cm的結(jié)節(jié)一次性消融率為62.5%。術(shù)后常規(guī)超聲隨訪所有結(jié)節(jié)體積較消融后1天明顯減小(P0.05),在最終評估時結(jié)節(jié)最大直徑從1.01±0.64cm減少到0.83±0.56cm,體積從0.30±0.37ml減少到0.17±0.20m1,最終隨訪結(jié)節(jié)平均體積減少率為71.8%。25.4%(30/118)結(jié)節(jié)消融術(shù)后12個月完全消失。治療前與術(shù)后1個月比較甲狀腺功能沒有明顯不同(P0.05)。激光消融治療的耐受性良好,3例患者術(shù)中有明顯疼痛感,1例(1.1%)患者出現(xiàn)喉返神經(jīng)損傷,治療后6個月內(nèi)聲音恢復(fù)正常。 結(jié)論：超聲引導(dǎo)下激光消融可有效滅活甲狀腺良性結(jié)節(jié),尤其適用于≤2cm的甲狀腺良性結(jié)節(jié)。激光是一種美容效果好、非常安全、有效的潛在可行的微創(chuàng)治療技術(shù),有望成為外科手術(shù)治療甲狀腺良性結(jié)節(jié)的重要補充。圖9幅,表2個,參考文獻(xiàn)27篇。
[Abstract]:Objective: To investigate the ablation morphology, range, temperature rise curve and other parameters of laser ablation of pig thyroid tissue under different power and different energy effects under ultrasound guidance, to evaluate its effectiveness, safety and feasibility, to determine the optimal power and total energy of the ablation thyroid tissue, and to provide the clinical application of laser ablation of thyroid nodules. Reference resources.
Materials and methods: using Italy Baisheng medical ECHO LASER integrated laser interventional ultrasound system. Under the guidance of ultrasonic guidance, the fresh isolated pig thyroid gland is laser ablation with different energy combinations. The ablation power is 1W, 2W, 3W, 4W, 5W, 6W, 7W, and the energy is 300J, 600J, 900J, etc., at the same time using thermocouples at the distance simultaneously. Real-time temperature measurement was performed at Omm, 5mm, 10mm, and 15mm. Ablation results were confirmed after ablation, and the ablation conditions were compared in each group.
Results: the ablation area was roughly elliptical, the ultrasound showed a central strong echo area, the peripheral strong echo area and the posterior echo were attenuated. After the incision, the center of the ablation area was observed in the center of the ablation area for the crumb like carbonized cavities, and the surrounding area was gray or light yellow necrotic tissue.HE staining: the center of the ablation area was in a regular oval shape. In the empty area, there were almost no dyed stains, a thin layer of carbonized layer and the most peripheral thyroid follicular in the periphery. The light microscope showed that the center was "hollow", the peripheral thyroid follicles decreased, the follicle epithelium contracted and the epithelial nuclei were obviously retracting. The temperature shows: the optical fiber center and the distance from the fiber 5mm of each group of power more than 2W The temperature was above 60 C. Statistical results showed that power 3W and energy were 1200-1800J, and the difference of ablation range was statistically significant (P0.05).
Conclusion: the ultrasound guided laser ablation of normal pig thyroid tissue is safe, the effect is clear, the ablation range is stable, the ablation range increases with the increase of power and energy. The best ablation effect can be obtained when the power is 3W and the energy is 1200-1800J. Figure 8, table 2, 28 references.
Background: laser ablation is a minimally invasive treatment method developed in recent years. There have been a lot of literature about laser ablation, but there are few literature reports about the radical treatment of laser ablation of thyroid nodules.
Objective: To investigate the feasibility, safety and clinical value of ultrasound guided percutaneous laser ablation for the treatment of benign thyroid nodules under ultrasound guided laser ablation.
Methods: 90 patients with 118 lesions were treated with ultrasound guided laser ablation in our hospital from September 2012 to April 2014. The thyroid function was examined and the clinical symptoms were evaluated before operation. The size and enhancement of all thyroid nodules were evaluated by conventional ultrasound and ultrasound contrast. The ablation power was set to 3W. A single needle, multiple or multi point ablation was taken according to the size of the nodules. The total ablation of the nodules was assessed by contrast-enhanced ultrasound 1 days after the operation. The volume of thyroid nodules, thyroid function, clinical symptoms and complications were evaluated at a follow-up period of 1,3,6,12,18 months after the operation. All patients were approved by our Institute of ethics. All of them obtained informed consent and signed written informed consent.
Results: all thyroid benign nodules were successfully treated with ablation. The one-time ablation rate of nodules with the maximum diameter of less than 1cm was 97.1%, the one-time ablation rate of nodules less than 2cm was 91.2%. The one-time ablation rate of 2cm nodules was 62.5%. after 62.5%., and all nodal volumes decreased significantly (P0.05) after 1 days after ablation. The maximum diameter of nodules decreased from 1.01 + 0.64cm to 0.83 0.56cm, and the volume decreased from 0.30 + 0.37ml to 0.17 + 0.20m1. The average volume reduction rate of final follow-up nodules was completely disappeared after 12 months after 71.8%.25.4% (30/118) ablation. There was no significant difference between the thyroid gland function and laser ablation before and 1 months after the treatment (P0.05). The treatment was well tolerated. 3 patients had significant pain during operation. 1 patients (1.1%) had recurrent laryngeal nerve injury, and their voice returned to normal within 6 months after treatment.
Conclusion: ultrasound guided laser ablation can effectively inactivate thyroid benign nodules and is especially suitable for thyroid benign nodules less than 2cm. Laser is a good, safe and effective minimally invasive technique for the treatment of thyroid benign nodules. It is expected to be an important supplement to the surgical treatment of thyroid benign nodules. Figure 9, table 2, reference 27 articles.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R736.1;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 屠規(guī)益;;學(xué)習(xí)國際經(jīng)驗要“思”——甲狀腺全切除術(shù)(器官切除)不是外科學(xué)發(fā)展方向[J];中國耳鼻咽喉頭頸外科;2008年12期

2 張先增;謝樹森;葉青;;脈沖激光輻照生物組織的體內(nèi)溫度分布及其對消融的影響[J];福建師范大學(xué)學(xué)報(自然科學(xué)版);2009年04期

3 劉娟;吳鳳林;隋洋;胡潔;;超聲引導(dǎo)下經(jīng)皮激光消融甲狀腺良性實性結(jié)節(jié)[J];南方醫(yī)科大學(xué)學(xué)報;2013年10期

4 劉佳雯;楊玉強(qiáng);張治國;;激光光動力學(xué)治療癌癥的新進(jìn)展[J];哈爾濱工業(yè)大學(xué)學(xué)報;2006年03期

5 張紀(jì)莊;張學(xué)學(xué);;激光蝕除生物組織的影響因素[J];中國激光;2007年02期

，

本文編號：1813686