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甲状腺危险部位结节的消融策略探究

发布时间:2019-03-23
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题目:甲状腺危险部位结节的消融策略探究
第一章:甲状腺结节和微波消融研究现状
第二章:甲状腺结节手术治疗资料与方法
第三章:微波手术在甲状腺结节中的应用结果与讨论
第四章-参考文献:甲状腺结节病症治疗分析结论与参考文献
  摘要
  
  目的: 探讨甲状腺良性结节微波消融治疗的临床疗效,危险部位结节的消融策略及并发症的防范处理。方法:回顾性分析兰州大学第一医院 2016 年 1 月—2017 年 1 月超声科微波消融治疗的 63 例甲状腺良性结节及随机抽取头颈外科收治的 68 例甲状腺良性结节外科传统手术病人相关资料,记录病人结节的数目、大小、位置、计算结节的体积大小,分析数据进行对比研究。微波消融病人术前均有病理结果证实为良性,外科手术病人术后病理结果证实为良性。通过对患者术后 1 月、3 月、6 月、12 月、18 月定期随访,明确以下内容:1.观察消融前与消融后 1、3、6、12、18 个月甲状腺结节体积及体积缩小率随时间的动态变化趋势。2.比较消融术前后甲状腺功能改变,比较消融术和外科手术后两组患者甲状腺功能的改变。3.对比分析消融术和传统外科手术后两组患者术后并发症发生率、手术时间、住院天数、术后颈部疤痕的大小、出血量的差异。4.分析危险部位结节的消融策略及并发症的防范处理。
  
  结果:1.消融组术后行超声造影未见造影剂灌注。CDFI:未见明显彩色血流信号。消融术前、术后 1、3、6、12、18 个月甲状腺结节的平均体积分别为 2.43ml、1.92ml、1.33ml、0.61ml、0.48ml、0.38ml,消融术后甲状腺结节的体积随随访时间的变化呈逐渐缩小的趋势,缩小率分别为 20.98%、45.37%、75.12%、80.10%和 84.30%,3 枚结节(3/66,4.55%)在随访 6-18 个月内消失。2.消融后游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺素与消融前均在正常范围内,消融组游离三碘甲状腺原氨酸、游离甲状腺素均高于手术组,促甲状腺素低于手术组,差异有统计学意义(P<0.05)。3.两组并发症发生率(血肿、感染、声音嘶哑、甲状旁腺损伤)差异无统计学意义(P>0.05);消融组甲减发生率为 0.00% (0 /63),手术组为 10.29%(7/68),消融组甲减的发生率低于手术组( χ2 = 4.967,P = 0.026),消融组总的并发症发生率低于手术组,差异有统计学意义( χ2 = 5.5941,P = 0.018) 。两组平均住院间、手术时间、出血量比较,消融组明显少于手术组,差异有统计学意义(P<0.05)。消融组术后几乎不留疤痕,手术组术后均留 5~7cm 横型疤痕,差异有统计学意义(P<0.05。

甲状腺结节和微波消融研究现状
  
  结论:1.消融组术后随访期间甲状腺结节体积明显渐次缩小,有 3 枚结节在术后随访期间完全消失。手术组术后结节均完全消失。微波消融术与手术切除甲状腺结节均可以有效消除甲状腺良性结节,但微波消融术手术疗效需要长期观察。2.微波消融治疗甲状腺结节术后甲状腺的功能与术前没有显着的差异,微波消融在有效治疗甲状腺结节的同时也保留了甲状腺的功能。外科手术切除治疗甲状腺功能伤害较大。3.微波消融治疗甲状腺良性结节之前,对结节部位进行良好的术前危险评估,消融过程中使用液体隔离带法和杠杆撬离法以及危险部位注射聚桂醇辅助消融等方法都可以有效的减低并发症的出现几率。4.超声引导下经皮微波消融治疗甲状腺良性结节,具有精准、美观、并发症少、创伤小、住院时间短、可重复操作等优点,效果良好,可广泛应用于临床当中,但其远期疗效有待进一步随访观察。关键词:甲状腺良性结节;微创治疗;微波消融。
  
  Abstract
  
  Objective: To explore the clinical efficacy of microwave ablation of benign thyroidnodules, ablation strategies of dangerous sites and the prevention and treatment ofcomplications.Methods: By retrospectively analyzing the related information about 63 patients withthyroid benign nodules, who were treated by ultrasonic intervention succormicrowave ablation and 68 patients treated of benign thyroid nodules traditionalsurgical operation in January 2016 - January 2017 in the first hospital of Lanzhouuniversity, the patient nodule number, size, location, calculated the volume of nodule size were recorded and the data were analyzed. All the patients withmicrowave ablation has the pathological results before surgery, proved to be benign,and those of the patients after surgery proved to be benign too. After 1 month, 3months, 6 months, 12 months and 18 months of regular follow-up, the followingcontents were clarifie 1. To observe the dynamic change trend of thyroid nodule volume and volumereduction rate with time before and after ablation at 1, 3, 6, 12, and 18 months.2. To compare changes of thyroid function before and after ablation, and thyroidfunction changes were compared between the two groups after ablation and surgery.3. To compare and analyze the differences in postoperative complications,operative time, length of stay, size of neck scars and blood loss between the twgroups.4. To analyze the ablation strategy of the dangerous nodules and the preventionand treatment of complications.Results:1. No contrast agent perfusion was observed after cues’ in the ablation group.CDFI: no obvious bleeding signal. The average volumes of thyroid nodule were 2.43ml and 1.92 ml, 1.33 ml and 0.61 ml, 0.48 ml and 0.38 ml before and after 1, 3, 6, 12,18 months of ablation surgery. After ablation the volume of thyroid nodule wasdiminishing along with the change of follow-up time, shrink rate were 20.98%45.37% 75.12%, 80.10% and 84.30%, three nodules, (3/66,4.55%) were melted awayin the follow-up of 6 to 18 months.2. After and before ablation, free triiodothyroiine, free thyrotropin andthyrot ropin we re all within the no rmal range. In the ablation group, freetriiodothyroiine and free thyroidine were all higher than those in the surgery group,and thyroidine was lower than those in the surgery group, which has statisticallysignificant differences (P<0.05).3. There was no statistically significant difference in the incidence ofcomplications (hematoma, infection, hoarseness, parathyroid damage) between thtwo groups (P>0.05). The incidence of hypothyroidism in the ablation group was 0%(0/63), 10.29% in the surgery group (7/68), the incidence of hypothyroidism in theablation group was lower than that in the surgery group( χ2 = 4.967,P = 0.026) , andthe total incidence of complications in the ablation group was lower than that in thesurgery group, which has statistically significant difference (χ2 = 5.5941, P = 0.018The mean length of hospital staying between the two groups was statisticallysignificant (P<0.05), and the ablation group was significantly lower than the surgerygroup. Almost no scars were left in the ablation group, and 5-7cm horizontal scarswere left in the surgery group, which has statistically significant differences (P<0.05).Conclusion: Comparison of hospitalization time, postoperative scar, operation timeand bleeding volume.1. During the postoperative follow-up of the ablation group, the thyroid noduleswere significantly reduced gradually, with 3 nodules completely disappeared duringthe postoperative follow-up. All the nodules disappeared after operation in surgerygroup. Microwave ablation and surgical resection of thyroid nodules can effectivelyeliminate thyroid benign nodules, but the efficacy of microwave ablation surgeryneeds long-term observation.2. There is no significant difference in thyroid function after microwave ablationfor thyroid nodules compared with that before surgery. While microwave ablation iseffective in treating thyroid nodules, it also retains thyroid’s function. Surgicalresection for thyroid’s function is more harmful.3. During the treatment of benign thyroid nodules with microwave ablation, thepreoperative risk assessment of nodules was performed well, and the use of liquiddissociation zone and lever dissociation as well as the injection of lauromacrogol atthe dangerous site could effectively reduce the occurrence of complications.4. The treatment of benign thyroid nodules by percutaneous microwave ablation underthe guidance of ultrasound has advantages of accuracy, aesthetics, less complications,less trauma, short hospitalization time and repeatable operation, which is effective andcan be popularized in clinical practice, but its long-term efficacy remains to be furtherfollowed up for observation.
  
  Keywords: benign thyroid nodules; minimally invasive treatment; microwave ablati
  
  目录
  
  摘要
  
  Abstract
  
  第一章 绪论
  
  1.1 甲状腺结节的研究现状.

  1.1.1 甲状腺结节的流行病学调查.
  1.1.2 甲状腺结节的诊断方法.
  1.1.3 甲状腺结节治疗方法.
  
  1.2 微波消融治疗.
  1.2.1 微波消融治疗的发展.
  1.2.2 微波消融的原理及作用机制.
  1.2.3 微波消融在甲状腺结节中的应用.
  1.2.4 微波消融临床治疗的展望.
  
  第二章 资料与方法
  
  2.1 研究对象.

  2.1.1 病例来源.
  2.1.2 入选标准.
  2.1.3 排除标准.
  
  2.2 设备与材料.
  
  2.3 治疗方法.

  2.3.1 微波消融手术方法.
  2.3.2 甲状腺切除手术方法.
  
  2.4 评价指标.

  2.5 统计学方法.

  
  第三章 结果与讨论
  
  3.1 结果.

  3.1.1 结节体积的变化.
  3.1.2 甲状腺功能.
  3.1.3 术后并发症.
  3.1.4 手术时间与疤痕.
  
  3.2 讨论.
  3.2.1 MWA 与手术切除的疗效比较.
  3.2.2 MWA 与手术切除的甲状腺损伤.
  3.2.3 MWA 与手术切除的并发症比较.
  3.2.4 甲状腺微波消融并发症的防范.
  
  第四章 结论
  
  参考文献