[1]陆晨雅,褚晓秋,陈国芳,等.微波消融治疗低危甲状腺微小乳头状癌的临床疗效和病理改变[J].国际内分泌代谢杂志,2021,41(03):184-190.[doi:10.3760/cma.j.cn121383-20210105-01009]
　Lu Chenya,Chu Xiaoqiu,Chen Guofang,et al.Clinical effects of microwave ablation in the treatment of low risk papillary thyroid microcarcinomas and related pathological changes[J].International Journal of Endocrinology and Metabolism,2021,41(03):184-190.[doi:10.3760/cma.j.cn121383-20210105-01009]
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微波消融治疗低危甲状腺微小乳头状癌的临床疗效和病理改变()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
41
期数:
2021年03期
页码:
184-190
栏目:
论著
出版日期:
2021-05-20

文章信息/Info

Title:
Clinical effects of microwave ablation in the treatment of low risk papillary thyroid microcarcinomas and related pathological changes
作者:
陆晨雅1; 褚晓秋1; 陈国芳1; 李兴佳1; 相萍萍1; 许洋1; 王雅琳1; 李杰2; 王建华3; 李瑞平4; 徐书杭1; 刘超1
1南京中医药大学附属中西医结合医院内分泌科 210028; 2南京中医药大学附属中西医结合医院超声科 210028; 3南京中医药大学附属中西医结合医院普外科 210028; 4南京中医药大学附属中西医结合医院病理科 210028
Author(s):
Lu Chenya1;  Chu Xiaoqiu1;  Chen Guofang1;  Li Xingjia1;  Xiang Pingping1;  Xu Yang1;  Wang Yalin1;  Li Jie2;  Wang Jianhua3;  Li Ruiping4;  Xu Shuhang
1Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine,Nanjing 210028, China; 2Department of Ultrasonography, Affiliated Hospital of Integrated
关键词:
甲状腺微小乳头状癌;  微波消融;  热消融;  病理改变
Keywords:
Papillary thyroid microcarcinoma;  Microwave ablation;  Thermal ablation;  Pathological changes
DOI:
10.3760/cma.j.cn121383-20210105-01009
摘要:
目的 评估超声引导下微波消融(MWA)治疗低危甲状腺微小乳头状癌(PTMC)的疗效与安全性,以及消融术后组织的病理学改变。方法 采用MWA治疗56例孤立性低危PTMC。消融时在超声引导下采取扩大消融。术后1 d和1、3、6、12个月进行超声随访,消融后前6个月同时监测甲状腺功能,术后3或6个月再次穿刺活检评估肿瘤残留,并记录并发症的情况。结果 本研究回顾性纳入56例PTMC消融患者,中位随访时间为6(3,12)个月,术后1年结节体积从0.05(0.04,0.12)cm3降至0.04(0.00,0.06)cm3(P<0.05),中位体积缩小率为64.99(-14.57,100)%,共有7例(12.50%)患者消融灶完全消失。PTMC经过MWA后,最常见的病理改变是纤维组织增生和慢性炎性反应(21/25,84.00%),其次是梗死。1例患者因术后1年时怀疑淋巴结转移接受外科手术,术后病理证实同侧甲状腺腺叶内存在1个意外发现的PTMC,但未发现淋巴结转移。所有患者并未发现远处转移。术后出现促甲状腺激素一过性降低(P<0.01),但远期与术前无明显差异。1例患者发生甲状腺功能减退症,1例患者发生短暂性声音嘶哑。结论 超声引导下MWA治疗低危PTMC的疗效良好,安全性较高。纤维组织增生和慢性炎性反应是消融术后最常见的病理改变。
Abstract:
Objective To evaluate the feasibility and efficacy of ultrasound-guided percutaneous microwave ablation(MWA)for the treatment of low-risk papillary thyroid microcarcinoma(PTMC), and observe the histopathological changes after MWA.Methods MWA was performed under ultrasound-guidance for 56 unifocal low risk PTMC. The target ablation zone exceeded the tumor edge judged by contrast-enhanced ultrasound. Ultrasound evaluation were followed at 1 day, 1, 3, 6 and 12 months after treatment and thyroid function evaluation conducted at the first 6 months. Repeated fine needle aspiration cytology or core needle biopsy pathology was performed at 3 or 6 months after MWA to evaluate residual tumors. Adverse event associated with MWA was recorded.Results A total of 56 patients with PTMC treated by MWA were retrospectively enrolled. The follow-up duration after MWA was 6(3, 12)months. Tumor volume decreased significantly from 0.05(0.04, 0.12)cm3 to 0.04(0.00, 0.06)cm3 at 12 months after MWA(P<0.05), with a median volume reduction ratio of 64.99(-14.57, 100)% and 7 cases(12.50%)got complete remission. The most common pathological characteristics were fibroblastic proliferation and chronic inflammation(21/25, 84.00%), followed by infarction. One patient was comfirmed with recurrence because of being suspected of cervical lymph node metastasis at 12 months follow-up and underwent a total thyroidectomy. An accidential PTMC was diagnosed by pathology at the ipsilateral thyroid lobe. No distant metastasis was observed. All the acquired histological pathology results confirmed the absence of residual or recurrent tumor cells after MWA. A transient decrease in serum thyrotropin was observed after MWA(P<0.01)but no difference patient had in the long term. One of these patients developed hypothyroidism and another patient had transient hoarseness.Conclusions MWA is a safe and effective treatment for low-risk PTMC. Fibroblastic proliferation and chronic inflammation are the most common pathological changes after MWA of PTMC.

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备注/Memo

备注/Memo:
通信作者:徐书杭,Email: shuhangxu@163.com; 刘超,Email: liuchao@nfmcn.com
更新日期/Last Update: 2021-05-20