本文選題：微波消融　切入點(diǎn)：結(jié)節(jié)性甲狀腺腫　出處：《重慶醫(yī)科大學(xué)學(xué)報(bào)》2016年12期

【摘要】：目的:探討四維B超引導(dǎo)定位下穿刺微波消融治療結(jié)節(jié)性甲狀腺腫(簡(jiǎn)稱"結(jié)甲腫")的臨床效果和可行性、安全性。方法:將2014年1月至2015年8月收治的127例結(jié)甲腫患者,采用隨機(jī)數(shù)字分配原則,分為結(jié)甲腫微波消融(消融組)64例,開放術(shù)式甲狀腺大部分切除含結(jié)節(jié)(開放組)63例。對(duì)2組患者術(shù)后結(jié)節(jié)吸收情況、術(shù)中出血量、手術(shù)時(shí)間、術(shù)后并發(fā)癥和術(shù)后疼痛、住院天數(shù)、甲狀腺功能等進(jìn)行比較。并總結(jié)結(jié)節(jié)消融后≥12個(gè)月的中遠(yuǎn)期隨訪結(jié)果。結(jié)果:消融組術(shù)中出血量[(2.13±0.83)vs.(26.30±17.90),P=0.000]、手術(shù)時(shí)間[(34.3±10.8)vs.(74.3±26.0),P=0.000]和住院天數(shù)[(3.64±1.23)vs.(10.50±3.15),P=0.000]方面明顯優(yōu)于開放組。此外,消融組術(shù)后疼痛的程度較開放組小(u=270.000,P=0.000),并發(fā)癥的發(fā)生也低于開放組(P=0.010)。通過對(duì)2組甲狀腺功能的分析,消融組與開放組的甲狀腺功能各項(xiàng)存在交互作用,各個(gè)時(shí)間點(diǎn)的差異均有統(tǒng)計(jì)學(xué)意義(P0.05),除T4外,其他甲狀腺功能各項(xiàng)在處理因素的主效應(yīng)均存在差異性(P0.005),而且消融組的均數(shù)水平波動(dòng)較小。消融組術(shù)后≥12個(gè)月的中遠(yuǎn)期隨訪患者27例,經(jīng)12~26個(gè)月的隨訪檢查,消融后≥18個(gè)月且21個(gè)月的6例患者,結(jié)節(jié)完全吸收率占66.67%;消融后≥21個(gè)月且26個(gè)月的10例患者,結(jié)節(jié)完全吸收率達(dá)100%。消融后結(jié)節(jié)復(fù)發(fā)1例,發(fā)現(xiàn)新生小結(jié)節(jié)1例,未發(fā)現(xiàn)甲狀腺功能減退癥病例。結(jié)論:微波消融比開放術(shù)式治療結(jié)甲腫的并發(fā)癥和出血量少、手術(shù)時(shí)間和住院天數(shù)短、術(shù)后疼痛輕,對(duì)甲狀腺功能影響小,是一種微創(chuàng)、美容、安全可行、效果確切的新技術(shù)。
[Abstract]:Objective: to investigate the clinical effect, safety and safety of microwave ablation for nodular goiter guided by four-dimensional B-ultrasound. Methods: 127 patients with nodular goiter were treated from January 2014 to August 2015. According to the principle of random digital distribution, the patients were divided into two groups: the ablation group (n = 64) and the open operation group (n = 63). Postoperative complications and postoperative pain, hospital stay, Results: the intraoperative bleeding volume [2.13 鹵0.83)vs.(26.30 鹵17.90], the operative time [34.3 鹵10.8)vs.(74.3 鹵26.0P0.000] and the length of hospitalization [3.64 鹵1.23)vs.(10.50 鹵3.15P0.000] in the ablation group were significantly better than those in the open group. The degree of postoperative pain in the ablation group was lower than that in the open group, and the incidence of complications was lower than that in the open group. Through the analysis of thyroid function in the two groups, there was interaction between the ablation group and the open group. The differences at all time points were statistically significant (P 0.05), except for T4, There were significant differences in the main effects of other thyroid function factors (P 0.005), and the mean level of the ablation group fluctuated little. 27 patients with 鈮，

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