超声引导经皮激光消融治疗单发甲状腺微小乳头状癌的疗效研究
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摘要
目的评估超声引导下经皮激光消融(PLA)治疗单发甲状腺微小乳头状癌(PTMC)的安全性及有效性。方法选取在我院超声科接受超声引导下PLA治疗的60例单发PTMC患者。治疗前均进行常规超声及超声造影(CEUS)检查评估甲状腺实质及淋巴结情况。治疗后24h行CEUS评估是否消融完全。治疗后1、3、6、12个月及以后每6个月,进行超声检查明确消融灶大小、颈部淋巴结及甲状腺实质情况,分析疗效。随访过程中,对出现的可疑转移淋巴结及甲状腺内可疑复发病灶行细针穿刺活检。结果所有60例患者成功进行激光消融治疗,均未出现严重并发症。60例患者于PLA治疗后24h行CEUS,均达到完全消融,单次消融成功率达100%。本研究平均随访时间(38.3±17.26)个月(12～66)个月,至最后一次随访时,54 (90%)个消融灶完全消失,6 (10%)个消融灶呈瘢痕样改变。随访期间,未发现淋巴结转移,1例(1.7%)患者出现局部复发,再次行PLA治疗。结论超声引导PLA治疗PTMC安全、可靠且疗效较好,可作为治疗部分PTMC的备选方案。
Objective To evaluate the efficacy and safety of percutaneous laser ablation(PLA)for unifocal papillary thyroid microcarcinoma(PTMC).Methods Sixty patients with PTMC in our hospital were treated with ultrasound-guided PLA.The extent of ablation was assessed by contrast-enhanced ultrasound(CEUS)in 24 hours after PLA.The size of the ablation zone,cervical lymph node,and thyroid parenchyma were followed up by ultrasound at 1,3,6 and 12 months,and every half year thereafter.During follow-up,fine needle aspiration biopsy was performed on suspicious metastatic lymph nodes and suspicious recurrent foci in the thyroid gland.Results All patients were completed the treatment successfully and the procedure was well tolerated without major complications.Sixty patients underwent CEUS 24 hours after PLA,and all showed complete ablation with a single ablation success rate of 100%.The average follow-up time of this study was(38.3±17.26)months(12-66)months.By the final follow-up,54(90%)ablation zones had disappeared completely and 6(10%)remained as scar-like changes.During the follow-up period,no lymph node metastasis was found,and one patient(1.7%)had local recurrence and was treated with PLA again.Conclusions Ultrasound-guided PLA treatment of PTMC is safe and effective,and can be used as an alternative to the treatment of some PTMC.
Objective To evaluate the efficacy and safety of percutaneous laser ablation(PLA)for unifocal papillary thyroid microcarcinoma(PTMC).Methods Sixty patients with PTMC in our hospital were treated with ultrasound-guided PLA.The extent of ablation was assessed by contrast-enhanced ultrasound(CEUS)in 24 hours after PLA.The size of the ablation zone,cervical lymph node,and thyroid parenchyma were followed up by ultrasound at 1,3,6 and 12 months,and every half year thereafter.During follow-up,fine needle aspiration biopsy was performed on suspicious metastatic lymph nodes and suspicious recurrent foci in the thyroid gland.Results All patients were completed the treatment successfully and the procedure was well tolerated without major complications.Sixty patients underwent CEUS 24 hours after PLA,and all showed complete ablation with a single ablation success rate of 100%.The average follow-up time of this study was(38.3±17.26)months(12-66)months.By the final follow-up,54(90%)ablation zones had disappeared completely and 6(10%)remained as scar-like changes.During the follow-up period,no lymph node metastasis was found,and one patient(1.7%)had local recurrence and was treated with PLA again.Conclusions Ultrasound-guided PLA treatment of PTMC is safe and effective,and can be used as an alternative to the treatment of some PTMC.
引文
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[7]马芳花,黄品同,戚瑞祥,等.超声引导下微波消融治疗甲状腺微小乳头状癌与外科手术切除的研究[J].中国超声医学杂志,2017,33(5):399-402.
[8]ZHOU W,JIANG S,ZHAN W,et al.Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0papillary thyroid microcarcinoma:Preliminary results[J].Eur Radiol,2017,27(7):2934-2940.
[9]李建如,罗渝昆,李岩密,等.超声引导下射频消融治疗甲状腺微小乳头状癌的疗效分析[J].解放军医学院学报,2016,37(8):823-826.
[2]PAPINI E,RAGO T,GAMBELUNGHE G,et al.Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules.Results of a three-year multicenter prospective randomized trial[J].J Clin Endocrinol Metab,2014,99(10):3653-3659.
[3]DI C G G,TORTORA R,D′ADAMO G,et al.Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis:a randomized trial[J].J Gastroenterol Hepatol,2015,30(3):559-565.
[4]ZHANG M,LUO Y,ZHANG Y,et al.Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Treating LowRisk Papillary Thyroid Microcarcinoma:A Prospective Study[J].Thyroid,2016,26(11):1581-1587.
[5]MA S,ZHOU P,WU X,et al.Detection of the Single-Session Complete Ablation Rate by Contrast-Enhanced Ultrasound during Ultrasound-Guided Laser Ablation for Benign Thyroid Nodules:A Prospective Study[J].Biomed Res Int,2016,2016:9565364.
[6]MAURI G,COVA L,IERACE T,et al.Treatment of Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma with Percutaneous Laser Ablation[J].Cardiovasc Intervent Radiol,2016,39(7):1023-1030.
[7]马芳花,黄品同,戚瑞祥,等.超声引导下微波消融治疗甲状腺微小乳头状癌与外科手术切除的研究[J].中国超声医学杂志,2017,33(5):399-402.
[8]ZHOU W,JIANG S,ZHAN W,et al.Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0papillary thyroid microcarcinoma:Preliminary results[J].Eur Radiol,2017,27(7):2934-2940.
[9]李建如,罗渝昆,李岩密,等.超声引导下射频消融治疗甲状腺微小乳头状癌的疗效分析[J].解放军医学院学报,2016,37(8):823-826.