超声引导激光消融治疗甲状腺乳头状癌的价值

Clinical value of ultrasound-guided laser ablation in treatment of local recurrence of thyroid papillary carcinoma

摘要:

目的 探讨超声引导激光消融对甲状腺乳头状癌局部复发的治疗效果。方法 收集2014 年12 月- 2016 年9 月上海市嘉定区安亭医院接受超声引导激光消融治疗的局部复发性甲状腺乳头状癌患者47 例。比 较患者治疗前后并发症的发生率及血清甲状腺球蛋白水平，并随访患者治疗后1、3、6、12 个月结节大小、 回声及血流。结果 ①患者出现术后恶心呕吐的发生率为19.15%，声音嘶哑发生率为21.28%，呛咳发生率为 8.51%，颈静脉血栓发生率为6.38%。②激光消融治疗后12 个月结节体积和直径低于治疗后1 个月，在治疗后 12 个月中呈逐渐缩小趋势，差异有统计学意义（P <0.05）。消融治疗在随访治疗后12 个月的结节回声消失和 血流信号消失的比率低于治疗后1 个月，差异有统计学意义（P <0.05）。③患者治疗后的血清甲状腺球蛋白 水平低于治疗前，治疗后1、3、6、12 个月之间比较，患者的血清甲状腺球蛋白水平呈逐渐下降趋势，差异有 统计学意义（P <0.05）。结论 超声引导激光消融具有安全性高、预后好、创伤小、恢复速度快的优点，可有 效治疗甲状腺乳头状癌局部复发，因此可作为甲状腺乳头状癌局部复发患者手术方式的一种选择。

Abstract:

Objective To investigate the therapeutic effect of ultrasound-guided laser ablation in the treatment of local recurrence of thyroid papillary carcinoma. Methods Forty-seven patients with local recurrence of thyroid papillary carcinoma in our hospital from December 2014 to September 2016 were involved. The patients received laser ablation under the guidance of ultrasound. The incidences of complications and serum thyroglobulin level of the patients before and after treatment were compared. The size, echo and blood flow of the nodules at 1, 3, 6 and 12 m after treatment were followed up. Results The incidence of postoperative nausea and vomiting was 19.15%, the incidence of hoarseness was 21.28%, the incidence of cough was 8.51%, and the incidence of jugular venous thrombosis was 6.38%. The volume and diameter of the nodules in 12 m after laser ablation treatment were significantly different from those in 1 m after treatment, there was a gradually decreasing trend within 12 m after treatment, and the differences were statistically significant (P < 0.05). The rates of disappearance of nodule echo and disappearance of blood flow signal at 12 m after treatment were lower than those at 1 m after treatment, the differences were statistically significant (P < 0.05). The serum thyroglobulin level after treatment was lower than that before treatment; the serum thyroglobulin level of the patients was in a decreasing trend from 1, 3, 6 m to 12 m after treatment, and the differences were statistically significant (P < 0.05). Conclusions Ultrasound-guided laser ablation has the advantages of safety, good prognosis, little trauma and fast recovery, and can effectively treat local recurrence of thyroid papillary carcinoma, therefore it can be expected as a choice of surgical treatment for local recurrence of thyroid papillary carcinoma.