甲狀腺微小乳頭狀癌經皮射頻消融近期臨床療效觀察

黃斌 孫希希 荀運浩 劉德林 王利虹 孔梓詳

甲狀腺微小乳頭狀癌經皮射頻消融近期臨床療效觀察

黃斌 孫希希 荀運浩 劉德林 王利虹 孔梓詳

目的 探討超聲引導下經皮射頻消融治療甲狀腺微小乳頭狀癌的臨床應用價值。方法 選取經細針穿刺細胞學活檢確診的甲狀腺微小乳頭狀癌患者 19 例，二維超聲示單發病灶，最大切面 2.4mm×3.0mm～ 8.0mm×8.9mm，均無淋巴結轉移。超聲引導下取 18G 射頻針行定點消融，擴大消融范圍，消融功率 35～45W，單一消融點消融時間 30～45s。詳細記錄術中及術后并發癥，術后定期超聲復查消融灶大小、有無復發病灶及淋巴結轉移情況。 結果 19 例甲狀腺微小乳頭狀癌病灶均完全消融滅活，消融過程順利。術中不適、術后局部隱痛等消融并發癥發生率 47.4%（9/19）。所有病灶均于術后 18 個月內完全消失，消融灶吸收呈“線”狀回聲。消融灶術后 1、3、6、12 個月平均縮小率分別為 11.2%、45.6%、63.1%、82.3%。隨訪期間未見復發病灶及頸部淋巴結轉移征象。 結論 超聲引導下經皮甲狀腺微小乳頭狀癌射頻消融近期療效顯著，創傷小，安全性高，且不影響美觀，值得臨床上應用并進一步觀察遠期療效。

甲狀腺微小乳頭狀癌 熱消融 射頻消融 超聲引導

【 Abstract 】 Objective To investigate the efficacy of percutaneous radiofrequency ablation in treatment of papillary thyroid microcarcinoma(PTMC). Methods Nineteen patients with PTMC diagnosed by fine needle aspiration wereselected.The ultrasonography showed single lesions in all cases with the maximum section of 2.4mm ×3.0mm-8.0mm ×8.9mm and no metastatic lymph nodes.The ablation was guided by ultrasound,with a power of 35-45W and ablation time of 30-45s for a single lesion.The intraoperative and postoperative complications,size of the ablation site,recurrence and lymph node metastasis were documented. Results The procedures were successful and all 19 lesions were completely ablated.The complications,including intraoperative discomfort and postoperative local pain,occurred in 9 patients(47.4%).All lesions completely disappeared within 18 months after procedure.The average reduction rates of lesions were 11.2%,45.6%,63.1%, 82.3%at 1,3,6,and 12 months after ablation,respectively.During the 18-month follow-up,no recurrence and cervical lymph node metastasis were found. Conclusion The short-term efficacy of ultrasound-guided percutaneous radiofrequency ablation for PTMC is satisfactory with noninvasiveness,safety and no adverse cosmetic effect,the long-term efficacy need to be confirmed.

【 Key words 】 Papillary thyroid microcarcinoma Thermal ablation Radiofrequency ablation Ultrasound guidance

隨著甲狀腺超聲檢查的普及和超聲引導下細針穿刺技術的廣泛應用，甲狀腺微小乳頭狀癌的檢出率呈上升趨勢[1-3]。手術切除為其首選治療方法。近年來，超聲引導下的熱消融技術也逐步開展[4-6]，并因其損傷小、恢復快且不影響美觀等優點受到關注；但也有觀點認為其發生癌灶殘留和淋巴結轉移風險較高，臨床尚存爭議[7-10]。……