摘要
目的：探讨超声引导下老年人甲状腺良性结节微波消融治疗的可行性及围手术期的安全性。方法回顾分析2009年7月至2015年10月期间滨州医学院烟台附属医院超声医学科收治的接受微波消融治疗的老年甲状腺良性结节患者471例（共1000枚结节）的临床资料。记录术中及术后所发生的不良反应及相应的治疗措施，术后通过超声造影判断消融范围。结果所有患者均在局麻下顺利完成消融治疗，其中完全消融者453例（共979枚结节），18例（21枚结节）因达胸骨后而进行了大部分消融。单结节消融时间为（150±103） s。结节无微循环灌注区范围与术前结节体积大小基本一致[（8.45±16.26） vs （8.66±15.61）cm^3，P＞0．05]，表明肿瘤组织灭活完全、无明显残留，结节达到完全消融。所有患者耐受性良好，无因术中不良反应及疼痛而终止手术者，疼痛分级0～5分者432例，术后发生急性左心衰1例、支气管痉挛1例。结论超声引导下经皮微波消融治疗老年甲状腺良性结节安全可行，值得临床推广。
Objective To investigate the feasibility and perioperative safety of microwave ablation for the elderly with benign thyroid nodules under ultrasound guidance .Methods A retrospective analysis was carried out on 471 elderly over 60 years old with benign thyroid nodules （ totally 1000 nodules ） who underwent microwave ablation under the ultrasound guidance in our department from July 2009 to October 2015.Intraoperative and postoperative adverse reactions and corresponding treatment measures were recorded . The ablation range was assessed by contrast-enhanced ultrasound examination after operation .Results Ultrasound guided percutaneous microwave ablation was successfully performed on all the 471 patients under local anesthesia .Among them, 453 patients with 979 nodules were ablated completely , and 18 patients with 21 nodules were ablated mostly because nodules grew behind the sternum.The ablation time for single nodule was （150 ±103）s.After the end of ablation, contrast enhanced ultrasound examination showed that the volume of no contrast agent filling area was （8.45 ±16.26）cm^3, which had no significant difference with the preoperative mean volume of nodules [（8.66 ±15.61）cm^3, P〉0.05].This indicated that tumor tissues were completely ablated , with no obvious residual, and the nodules achieved complete ablation .All patients had good tolerance , and no adverse effects and pain terminated the surgical treatment.There were 432 patients having pain grade of 0-5.After operation, 1 case suffered from left heart failure , and the other one from bronchial spasm .No severe complications were found in the subjects .Conclusion Percutaneous microwave ablation under ultrasound guidance is a safe and effective approach for the elderly with benign thyroid nodules .It is worthy of promotion in clinical practice .
出处
《中华老年多器官疾病杂志》
2016年第7期495-499,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
山东省科技发展计划(2011YD18028)
烟台市科技攻关计划(2010156)~~
关键词
老年人
超声引导
微波消融
甲状腺良性结节
围手术期
aged
ultrasound guidance
microwave ablation
benign thyroid nodules
perioperative period
