本文選題：甲狀腺良性結(jié)節(jié) + 微波消融�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]研究超聲引導(dǎo)下經(jīng)皮微波消融治療甲狀腺良性結(jié)節(jié)的療效、甲狀腺功能以及并發(fā)癥,并與同期手術(shù)患者比較美觀效果、疼痛及手術(shù)麻醉反應(yīng)評(píng)分。[方法]2015年11月至2016年11月期間,選取在本院實(shí)施微波消融治療的甲狀腺良性結(jié)節(jié)患者共56例72枚結(jié)節(jié)。操作過(guò)程:術(shù)前在超聲引導(dǎo)下行細(xì)針穿刺細(xì)胞學(xué)檢查,確定結(jié)節(jié)性質(zhì)后,根據(jù)病變大小和位置,制定治療方案,按照消融操作過(guò)程進(jìn)行消融。術(shù)后隨訪和療效評(píng)價(jià):消融患者術(shù)后隨訪1個(gè)月、3個(gè)月、6個(gè)月、12個(gè)月,采用彩色多普勒超聲分別測(cè)定甲狀腺結(jié)節(jié)大小、邊界、內(nèi)部回聲、血流變化,術(shù)后第1個(gè)月行超聲造影評(píng)估結(jié)節(jié)微血管損毀程度和新生血管形成,統(tǒng)計(jì)消融區(qū)體積、體積縮小率、甲狀腺功能、并發(fā)癥,并與同期手術(shù)病人比較美觀效果、疼痛及手術(shù)麻醉反應(yīng)評(píng)分。[結(jié)果]1.超聲表現(xiàn):消融完成后,原包塊區(qū)域?yàn)橐粓F(tuán)狀強(qiáng)回聲區(qū),邊界清晰,后方回聲輕度衰減,隨訪中表現(xiàn)為界限清晰的低回聲。彩色多普勒超聲顯示結(jié)節(jié)內(nèi)部血流信號(hào)消失,周?chē)聪趨^(qū)血流信號(hào)正常。2.病灶吸收情況:1)微波消融后第1個(gè)月,結(jié)節(jié)體積開(kāi)始減小,隨訪結(jié)果顯示可見(jiàn)消融區(qū)結(jié)節(jié)在術(shù)后1個(gè)月、3個(gè)月、6個(gè)月和12個(gè)月的體積出現(xiàn)不同程度的進(jìn)行性縮小,其體積縮小率為40. 4%、58.61%、75.8%、71.81%,與術(shù)前比較差異具有統(tǒng)計(jì)學(xué)意義(P0. 05),其中6月時(shí)體積縮小速度最快(P0. 05 VS 3月),12月縮小速度減慢(P0. 05 VS 6月);2)術(shù)后隨訪期間共有39枚結(jié)節(jié)基本完全吸收,吸收率為54.17% (39/72),13枚結(jié)節(jié)隨訪時(shí)間小于12月,另見(jiàn)3枚結(jié)節(jié)復(fù)發(fā),復(fù)發(fā)率4.17% (3/72); 3)術(shù)后1個(gè)月和3個(gè)月,混合結(jié)節(jié)組體積縮小程度較實(shí)性結(jié)節(jié)體積縮小程度更為顯著,但兩組結(jié)節(jié)自3個(gè)月之后的體積減小百分比無(wú)明顯統(tǒng)計(jì)學(xué)差異;4)直徑為0～20mm與31～40mm組在術(shù)后1個(gè)月時(shí)消融區(qū)的體積縮小程度較另外一組更為顯著,且直徑0～20mm組在術(shù)后6個(gè)月時(shí)消融區(qū)的體積縮小率大于另外兩直徑組,其余隨訪時(shí)間三組結(jié)節(jié)體積縮小無(wú)明顯統(tǒng)計(jì)學(xué)差異。3.甲狀腺功能:微波消融治療甲狀腺結(jié)節(jié)會(huì)引起少量周?chē)Ｏ袤w組織損傷,甲狀腺功能無(wú)明顯影響,無(wú)臨床癥狀。4.并發(fā)癥:1)術(shù)中即刻出現(xiàn)聲音改變11例(19. 64%),持續(xù)時(shí)間1～2 h后自行緩解消失;2)在開(kāi)展初期有4例(7.14%)患者在術(shù)后6～48 h后出現(xiàn)發(fā)聲困難、聲音嘶啞,治療后1～3個(gè)月后,聲音恢復(fù)正常;3) 3例(5.37%)出現(xiàn)皮膚灼傷;4) 9例(16.07%)出現(xiàn)血管迷走神經(jīng)反應(yīng);5) 7例(12. 5%)出現(xiàn)疼痛,加注利多卡因緩解;6)所有患者術(shù)后出現(xiàn)局部不同程度術(shù)區(qū)腫脹,予冰敷及壓迫處理后癥狀減輕。5.術(shù)后主觀效果評(píng)價(jià):通過(guò)消融組與同期手術(shù)病檢良性的患者進(jìn)行對(duì)比,我們發(fā)現(xiàn)消融組在美觀效果、疼痛、手術(shù)麻醉反應(yīng)評(píng)分上均明顯好于手術(shù)組,差異具有統(tǒng)計(jì)學(xué)意義(P0. 05)。[結(jié)論]1、消融后第6月,消融區(qū)吸收速度較快,之后吸收速度慢,術(shù)后6個(gè)月可作為評(píng)價(jià)甲狀腺良性結(jié)節(jié)微波消融后吸收效果的重要時(shí)間2、微波消融在美觀效果、疼痛和手術(shù)麻醉反應(yīng)評(píng)分的術(shù)后主觀效果評(píng)價(jià)上優(yōu)于手術(shù),達(dá)到良好的微創(chuàng)效果。3、超聲造影是檢測(cè)病變微血管灌注的一種方法,可用于識(shí)別殘留病灶并補(bǔ)充消融,還可評(píng)估消融灶范圍,隨訪時(shí)了解復(fù)發(fā)情況。4、超聲引導(dǎo)微波消融治療甲狀腺良性結(jié)節(jié)是一種有效、美觀、并發(fā)癥少的治療方法,在掌握適應(yīng)癥的前提下,可以作為一種新的治療方法。
[Abstract]:[Objective] to study the efficacy of ultrasound guided percutaneous microwave ablation in the treatment of benign thyroid nodules, thyroid function and complications, and to compare the aesthetic effect, pain and surgical anaesthesia score of the patients in the same period. [methods]2015 year November to November 2016, the thyroid benign nodules were selected in our hospital for microwave ablation. The patient had 56 cases of 72 nodules. Operation: before operation, a fine needle aspiration cytology was conducted under the guidance of ultrasonic guidance. After the nodules were determined, the treatment plan was made according to the size and position of the lesion. The ablation was performed according to the ablation operation. Postoperative follow-up and evaluation of the curative effect: the ablation patients were followed up for 1 months, 3 months, 6 months, 12 months, with color. The size, boundary, internal echo and blood flow of thyroid nodules were measured by Doppler ultrasound, and the degree of microvascular damage and neovascularization were assessed by ultrasound first months after operation. The volume of ablation area, volume reduction, thyroid function, complications, and the aesthetic effect, pain and operation anesthesia were compared with the patients in the same period. The results of]1. ultrasound showed that after the ablation was completed, the area of the original mass was a dense echo area, the boundary was clear, the posterior echo was slightly attenuated, and the follow-up showed a clear low echo. The color Doppler ultrasound showed that the blood flow signals disappeared in the nodules and the normal.2. focus absorption of the blood flow signals in the surrounding unablated area: 1) microwave elimination First months after thawing, the volume of nodules began to decrease. The follow-up results showed that the volume of the ablation zone nodules appeared at 1 months, 3 months, 6 months and 12 months after operation. The volume reduction rate was 40.4%, 58.61%, 75.8%, 71.81% (P0. 05), in which the volume decreased in June. The fastest (P0. 05 VS March), reduced speed in December (P0. 05 VS June); 2) 39 nodules were absorbed completely, the absorption rate was 54.17% (39/72), 13 nodules were followed up less than December, 3 nodules recurred, and the recurrence rate was 4.17% (3/72); 3) 1 months and 3 months after operation, the volume reduction of the mixed nodule group was more solid. The volume reduction of nodules was more significant, but there was no significant difference in the volume reduction of two groups of nodules since 3 months. 4) the size of the ablation area was more significant than the other group at 1 months after the operation, and the diameter from 0 to 20mm and 31 to 40mm was more significant than that in the other group, and the size of the ablation zone in the 0 ~ 20mm group was larger than that in the group 0 to the 6 months after the operation. In the other two diameter group, there was no significant difference in the volume of the three groups of nodules in the rest of the follow-up time.3. thyroid function: the treatment of thyroid nodules by microwave ablation could cause a small amount of peripheral normal gland tissue injury, there was no obvious effect on thyroid function, no clinical symptoms of.4. complication: 1) 11 cases (19.64%), continuous sound changes during the operation (19.64%), sustained After 1~2 h, 4 cases (7.14%) had dysphonia, hoarseness, sound hoarseness and normal sound recovery after 1~3 months of operation; 3) 3 cases (5.37%) appeared skin burns; 4) 9 cases (16.07%) appeared the vagus nerve reaction of the blood tube; 5) the occurrence of pain and lidocaine relieved. 6) all patients had local swelling in different extent after operation, and the subjective effect of.5. after operation was evaluated after ice compress and compression treatment. By comparing the ablation group with the patients with benign surgical examination, we found that the ablation group was better than the operation group in the aesthetic effect, pain and surgical anesthesia score. Study significance (P0. 05). [conclusion]1, sixth months after ablation, the absorption speed of the ablation area is faster, then the absorption speed is slow, and 6 months after the operation can be used as an important time to evaluate the absorption effect of the thyroid benign nodules after microwave ablation, and the microwave ablation is superior to the operation in the aesthetic effect, pain and surgical anesthesia score. To a good minimally invasive effect.3, contrast-enhanced ultrasound is a method for detecting microvascular perfusion, which can be used to identify residual lesions and supplement ablation, to evaluate the range of ablation range, to understand the recurrence of.4. Ultrasound guided microwave ablation for benign thyroid nodules is an effective, beautiful, and less complication treatment. Under the premise of indications, it can be used as a new treatment method.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R581

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本文編號(hào)：2110029