本文選題：甲狀腺微小癌　切入點(diǎn)：微波消融術(shù)　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的近年來由于高頻率彩超以及彩超引導(dǎo)下細(xì)針穿刺學(xué)的使用,甲狀腺微小癌在人群中的發(fā)生率較以往增高顯著,對于如何治療越來越備受關(guān)注,尤其對于一些因無法耐受手術(shù)的人群,以及術(shù)后并發(fā)癥等原因拒絕外科開放手術(shù)的人群,病灶只能定期觀察,但病灶仍有可能發(fā)生早期淋巴結(jié)轉(zhuǎn)移。隨著微波消融術(shù)近年來的發(fā)展。目前已經(jīng)在肝臟惡性腫瘤以及良性甲狀腺結(jié)節(jié)治療中獲取顯著療效,對其操作已經(jīng)有了熟悉的掌握。因此我們將探討B(tài)超引導(dǎo)下經(jīng)皮冷循環(huán)微波消融(MA)治療甲狀腺微小癌的臨床應(yīng)用價(jià)值,避免了患者定期觀察帶來的危險(xiǎn),同時(shí)相對于傳統(tǒng)開放手術(shù),微波消融術(shù)具有創(chuàng)傷小、手術(shù)時(shí)間短、恢復(fù)快、無疤痕、并發(fā)癥少等優(yōu)點(diǎn)。雖然是一種微創(chuàng),但追其原理,仍會對機(jī)體組織產(chǎn)生一定損傷。對于其損傷的嚴(yán)重性我們選取了腫瘤壞死因子α(Tumor Necrosis Factor-α,TNF-α)、C反應(yīng)蛋白(C-reactive protein,CRP)兩種因子。它們是反應(yīng)手術(shù)對機(jī)體損傷嚴(yán)重程度的常見指標(biāo)。同時(shí)甲狀腺激素是反映甲狀腺功能重要指標(biāo)。因此我們通過測定微波消融術(shù)前術(shù)后血清TNF-α、CRP、血清游離三碘甲腺原氨酸(f T3)、血清游離甲狀腺素(f T4)、促甲狀腺激素(TSH)的含量變化,以及隨訪中結(jié)合彩超檢測甲狀腺病灶消融術(shù)后體積縮小率的變化等。用以探討該治療方法的應(yīng)用價(jià)值。方法選取2014年3月~2015年3月期間我院普外科經(jīng)頸部檢查考慮甲狀腺微小癌的患者12例(12枚病灶),患者均在B超引導(dǎo)下行細(xì)針穿刺學(xué)證實(shí)為甲狀腺微小癌。均無淋巴結(jié)轉(zhuǎn)移且患者希望首選非開放手術(shù)治療�；颊呔x擇超聲引導(dǎo)下進(jìn)行甲狀腺病灶的經(jīng)皮穿刺冷循環(huán)微波消融術(shù)治療。微波消融術(shù)后應(yīng)用多普勒超聲進(jìn)行定期隨訪;采用ELISA法測定患者術(shù)前、術(shù)后12h的C反應(yīng)蛋白(CRP)及腫瘤壞死因子(TNF-α)的指標(biāo),并進(jìn)行術(shù)前與術(shù)后的比較;采用電化學(xué)發(fā)光免疫法測血清游離三碘甲腺原氨酸(FT3)、血清游離甲狀腺素(FT4)、促甲狀腺激素(TSH)的含量變化,同時(shí)對術(shù)后癌灶消融區(qū)域體積縮小率進(jìn)行計(jì)算以及術(shù)中出血量、住院時(shí)間以及術(shù)后并發(fā)癥進(jìn)行總結(jié)。結(jié)果(1)微波消融術(shù)前、術(shù)后12h CRP分別為:(0.6±0.2)mg/L、(0.6±0.3)mg/L,術(shù)前、術(shù)后TNF-α分別為(38.2±4.9)ng/L、(39.8±3.9)ng/L。微波消融術(shù)前、術(shù)后兩種創(chuàng)傷因子均有輕微的上升,分析消融前后兩種因子的變化均無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)微波術(shù)前與術(shù)后1、3、6、12、18個(gè)月TSH的值分別為(m IU/m L):2.59±1.01、2.59±1.1、2.56±1.10、2.66±1.06、2.63±1.17、2.61±1.11;FT3的值分別為(pmol/L):4.93±0.67、4.88±0.61、4.86±0.57、4.81±0.6、4.80±0.52、4.83±0.49;FT4的值分別為(pmol/L):15.21±1.34、15.13±1.08、15.11±1.05、14.86±1.08、14.76±1.16、14.3±1.26。術(shù)前與術(shù)后TSH、FT3、FT4測得值未見明顯變化,分析其結(jié)果無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)對微波消融術(shù)后1、3、6、12、18個(gè)月的隨訪,其病灶體積縮小率平均分別為13.5(12.8~14.1)、42.5(32.8~50.6)、70.2(66.8~78.0)、81.0(79.0~86.2)、88.2(83.1~99.8)。(4)消融后彩超多普勒顯示未受消融的正常腺體區(qū)域彩超血流信號依舊而消融區(qū)的血流信號完全喪失。甲狀腺癌未見復(fù)發(fā),周圍淋巴結(jié)未見異常。(5)所有患者術(shù)中出血少,住院時(shí)間短、恢復(fù)可,術(shù)后均未見出血及血腫、劇痛、聲音嘶啞、氣管食管損傷及其他嚴(yán)重并發(fā)癥�；颊呔鶎ζ渲委熃Y(jié)果滿意。結(jié)論微波消融術(shù)是治療單發(fā)無淋巴結(jié)轉(zhuǎn)移的甲狀腺微小癌的一種微創(chuàng)治療方式。具有安全、有效、創(chuàng)傷小、美觀、術(shù)后恢復(fù)快、無手術(shù)疤痕等優(yōu)點(diǎn)。
[Abstract]:Objective in recent years due to the high frequency ultrasound and ultrasound guided fine needle aspiration biopsy of thyroid microcarcinoma, the incidence was significantly higher than in the past, for how to treat more and more concern, especially for some of the people can not tolerate surgery, refused to open surgical operation crowd reasons and postoperative complications, lesions only regular observation, but the lesions may still occur early lymph node metastasis. With the development of microwave ablation in recent years. At present already gets obvious curative effect in liver malignant tumor and benign thyroid nodules in the treatment of the operation has been familiar with the master. So we will explore the ablation percutaneous ultrasound guided microwave (cold circulation MA) treatment of thyroid microcarcinoma clinical value, to avoid the risk of patients were observed regularly at the same time, compared with the traditional open surgery, microwave ablation. There is little trauma, short operation time, quick recovery, no scars, less complications. It is a minimally invasive, but the principle will still produce some damage to the body. For the serious injury we selected tumor necrosis factor alpha (Tumor Necrosis Factor- TNF- C, alpha, alpha) reaction protein (C-reactive protein, CRP) two factors. They are common indicators of the severity of injury surgery on the body. At the same time, thyroid hormone is an important indicator to reflect the thyroid function. Therefore we measured the microwave ablation before and after serum TNF-, CRP, serum free three triiodothyronine (f T3), serum free thyroxine (f T4), thyroid stimulating hormone (TSH) content changes, and follow-up with ultrasound detection of thyroid lesions after ablation volume reduction rate changes. In order to explore the method of treatment application value. Methods from March 2014 ~20 In March 15 during the Department of general surgery of our hospital was considered neck examination of 12 cases with thyroid microcarcinoma patients (12 lesions), patients in the ultrasound guided fine needle aspiration biopsy revealed thyroid microcarcinoma. There were no lymph node metastasis in patients with non preferred and hope open surgery patients were selected. Percutaneous microwave ablation cooling cycle the treatment of thyroid lesions under ultrasound guidance. Regular follow-up by Doppler ultrasound after microwave ablation; ELISA method was used to determine the preoperative, postoperative reaction of protein 12h C (CRP) and tumor necrosis factor alpha (TNF- alpha) index, compared with the postoperative and preoperative measurement of serum free; chemiluminescence immunoassay three triiodothyronine (FT3) by electrochemical, serum free thyroxine (FT4), thyroid stimulating hormone (TSH) content changes, at the same time of postoperative tumor ablation area size calculation and intraoperative bleeding rate, live 闄㈡椂闂翠互鍙?qiáng)鏈悗迤堝彂鐥嚇q涜鎬葷粨.緇撴灉(1)寰嘗娑堣瀺鏈墠,鏈悗12h CRP鍒嗗埆涓，

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