發(fā)布時間：2018-07-17 06:08

【摘要】：目的：對微波消融治療良性甲狀腺病變臨床應用的具體技術，評價方法、療效和安全性做進一步研究，對惡性病變治療的可行性進行探索。方法：選取2010年11月至2014年04月在我科行超聲引導下微波消融治療的甲狀腺良性結節(jié)患者76例共88個結節(jié)，平均直徑3.2±1.6cm；甲狀腺惡性病灶共7例7個病灶消融均采用水冷微波天線及康友（南京）KY-2000型微波消融治療儀（頻率2450MHz）進行治療。選取其中22例25個病灶于術前及術后進行彈性成像并測定彈性指數（E）及彈性比率值（Ratio）進行定量分析。其中按照消融方式將病灶分為固定針消融組（n=42）和移動消融組（n=39），并分階段統(tǒng)計兩組及總體的病灶縮小率，比較兩組消融手術參數、消融范圍及縮小率間的差異。結果：隨訪1-26個月，結節(jié)縮小率為51.23±31.97%。消融治療后疼痛及癥狀評分、血流評分及美觀評分均降低（p0.05)。消融后出現甲狀腺功能指標TT3、游離TT4的升高和TSH的降低具有統(tǒng)計學差異(p0.01)。消融后E值高于消融前（P=0.008），其中實性為主及病理為腺瘤的病灶E值升高明顯（p=0.041；p=0.036）。移動消融組治療單位體積用時較固定消融組短（p=0.027）各階段體積縮小率均高于固定消融組，，其中3-6個月時有統(tǒng)計學意義（p=0.041）。結論：微波消融治療甲狀腺良性結節(jié)的效果確實，對患者頸部美觀改善明顯，副作用和并發(fā)癥少且輕。采用移動消融技術療效確切且治療效率更高，消融范圍更適形更完全。手術前后采用組織彈性定 量分析對于實性為主及腺瘤性質的病灶有一定應用價值，有望成為術中無創(chuàng)檢測消融范圍的方法。微波消融可以用于單發(fā)無明確腺體外及淋巴結轉移的甲狀腺惡性病灶治療。該方法雖尚不能替代手術，但在判斷好適應癥的情況下選擇合適病例進行局部消融治療是可行的。 目的：本研究的目的是分析北京地區(qū)居民甲狀腺腫及甲狀腺結節(jié)的發(fā)病影響因素及患病特征，并從流行病學角度探討開展熱消融治療甲狀腺病變的前景。方法：通過整群抽樣選擇北京市城區(qū)及郊區(qū)常住居民10000名，年齡18-75歲，無嚴重器官功能損害，進行病史采集、問卷調查及超聲檢查，并獲得完整資料6323例，男性2263例，女4060例，平均年齡為51.44±11.72歲。對該地區(qū)甲狀腺腫及甲狀腺結節(jié)患病率，患病特征及相關影響因素進行統(tǒng)計和分析。結果：經超聲篩查得到的甲狀腺腫及結節(jié)的總患病率為57.68％，女性患病率明顯高于男性，（p＜0.001），并且患病率隨年齡增長而逐漸增加。該地區(qū)人群男女間甲狀腺結節(jié)的單多發(fā)比例間的差異（p=0.001)，男性以單發(fā)結節(jié)多見，女性則多發(fā)結節(jié)的比例更高。年齡、性別、高血壓病、糖尿病、吸煙等多種因素影響該地區(qū)結節(jié)的患病率（p＜0.05）。結論：北京地區(qū)甲狀腺腫及甲狀腺結節(jié)的患病率高，患病影響因素較多，疾病的預防應注重對生活習慣的糾正及基礎疾病的控制。部分患者采用現有方式治療不理想或不適合，需要療效確切、可重復、適應癥更廣的新方法。 目的：通過開展前瞻性的大樣本量多中心研究，對熱消融治療主要技術（微波、射頻、激光）的臨床應用情況進行對比，以期得出熱消融療效、安全性以及操作方法的更全面可靠的高級別的循證醫(yī)學數據。方法：選取2013年2月至2014.3月之間在中國12家醫(yī)院接受超聲引導下熱消融治療甲狀腺良性結節(jié)的患者340例共437個病灶，平均年齡46.23±12.47歲。分別采取射頻、微波、激光三種技術進行消融治療。消融前后行超聲及造影檢查評價結節(jié)的初始大小及消融范圍，對患者治療前后的臨床癥狀體征、頸部外觀、結節(jié)血流等主觀評價指標進行量化評分，記錄并發(fā)癥的情況。結果：隨訪1-12個月，得到結節(jié)縮小率為63.72±68.87%，消融治療后血流評分、美觀評分及疼痛癥狀評分均降低明顯（p0.01)。消融后出現甲狀腺功能指標TT3、TT4、fT3、fT4的升高和TSH的降低(p0.001)。分別采用射頻消融、微波消融、激光消融治療病灶數量分別為236個、199個、3個，對射頻消融及微波消融進行對比分析得到微波組治療時間短，且術后縮小率高于射頻組（p＜0.05）。結論：熱消融治療甲狀腺良性結節(jié)的療效確切，安全性較高。中期結果表明研究進展基本達到預期，納入考量的指標均有陽性結果，暫無需調整研究方案，但尚需補充激光消融病例作為對比參照。
[Abstract]:Objective: To study the specific techniques, evaluation methods, efficacy and safety of microwave ablation in the treatment of benign thyroid lesions, and to explore the feasibility of the treatment of malignant lesions. Methods: 76 cases of benign thyroid nodules treated by ultrasound guided micro wave ablation in our department from November 2010 to 04 2014 were selected. A total of 88 nodules, with an average diameter of 3.2 1.6cm, were treated with water cooled microwave antenna and KY-2000 type microwave ablation therapy instrument (frequency 2450MHz) in 7 cases of malignant thyroid lesions. 22 of them 25 lesions were selected before and after operation, and the elastic index (E) and elastic ratio were measured (Ratio The lesions were divided into fixed needle ablation group (n=42) and mobile ablation group (n=39) according to the method of ablation. The two groups and the overall reduction rate of focus were statistically analyzed. The differences of ablation operation parameters, ablation range and reduction rate were compared between the two groups. The results were followed up for 1-26 months, the reduction rate of nodules was 51.23 + 31.97%. ablation treatment. After the ablation, the score of pain and symptoms, the score of blood flow and the aesthetic score were all decreased (P0.05). The thyroid function index TT3, the increase of free TT4 and the decrease of TSH were statistically different (P0.01). The E value after ablation was higher than that before ablation (P=0.008), in which the E value of the solid and pathological adenoma increased significantly (p=0.041; p=0.036). Movement elimination (p=0.036). The volume reduction rate in each stage of the unit volume was higher than that of the fixed ablation group (p=0.027), which was significantly higher than that in the fixed ablation group (p=0.041) at 3-6 months. Conclusion: the effect of microwave ablation in the treatment of benign thyroid nodules is indeed obvious, and the side effects and complications are less and lighter. The curative effect of the fusion technique is definite and the treatment efficiency is higher, and the ablation range is more complete.
Quantitative analysis is of certain value for solid and adenomatous lesions. It is expected to be a noninvasive method in the operation. Microwave ablation can be used for the treatment of solitary thyroid malignant lesions with no clear gland in vitro and lymph node metastases. This method can not be used instead of hand surgery, but it is selected in the judgement of good indications. It is feasible to treat appropriate cases with local ablation.
Objective: the purpose of this study was to analyze the factors affecting the incidence of goiter and thyroid nodules in Beijing residents, and to explore the prospect of heat ablation in the treatment of thyroid diseases from the epidemiological point of view. Methods: 10000 permanent residents in urban and suburban areas of Beijing were selected by cluster sampling, and the age of 18-75 years old was not serious. Organ dysfunction, medical history collection, questionnaire survey and ultrasound examination, and 6323 cases of complete data, 2263 males and 4060 females, with an average age of 51.44 + 11.72 years. The prevalence of goiter and thyroid nodules in this area, the prevalence of thyroid nodules, the characteristics of the disease and the related factors were analyzed. The total prevalence rate of adenoma and nodule was 57.68%, and the prevalence rate of female was significantly higher than that of men (P < 0.001), and the prevalence rate increased with age. The difference of single incidence of thyroid nodules between men and women in this area (p=0.001), male with single nodules, and higher proportion of multiple nodules in women. Age, sex, high blood Many factors such as pressure disease, diabetes, smoking and other factors affect the prevalence of nodules in the region (P < 0.05). Conclusion: the prevalence of goiter and thyroid nodules in Beijing region is high, and there are many factors affecting the disease. The prevention of disease should pay attention to the correction of living habits and control of basic diseases. It is suitable for a new method with definite curative effect, repeatability and wider indications.
Objective: To compare the clinical application of the main techniques (microwave, radiofrequency, and laser) for the treatment of heat ablation in order to obtain the more comprehensive and reliable evidence-based medical data of the heat ablation effect, safety and operation methods. Methods: from February 2013 to 2014.3 months. 340 cases of thyroid benign nodules were treated by ultrasound guided thermal ablation in 12 hospitals in China. The average age was 46.23 + 12.47 years old. Radiofrequency, microwave, and laser ablation were used for ablation treatment. The initial size and ablation range of the nodules were evaluated before and after ablation. The clinical symptoms, signs, neck appearance, nodular blood flow and other subjective evaluation indexes were quantified, and the complications were recorded. Results: 1-12 months of follow-up, the reduction rate of nodules was 63.72 + 68.87%. After ablation treatment, the blood flow score, aesthetic score and pain symptom score decreased significantly (P0.01). The thyroid function index was TT3 after ablation. TT4, fT3, fT4 increased and TSH decreased (p0.001). The number of lesions treated with radiofrequency ablation, microwave ablation, and laser ablation were 236, 199, 3, respectively, and compared to the radiofrequency ablation and microwave ablation, the time of microwave therapy was shorter and the reduction rate was higher than that of the radio frequency group (P < 0.05). Conclusion: heat ablation of thyroid The curative effect of benign nodules is accurate and the safety is high. The mid-term results show that the progress of the study is basically expected, and the indicators in the examination are positive, and there is no need to adjust the study scheme for the time being, but the cases of laser ablation need to be supplemented as a comparative reference.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R581

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