超聲引導下射頻與微波消融治療甲狀腺良性結節的比較

張秀芳 劉景萍 胡健 馬金秋

[摘要] 目的 比較超聲引導下射頻與微波消融治療甲狀腺良性結節的臨床效果。 方法 選擇2013年8月～2017年1月在唐山市人民醫院診治的92例甲狀腺良性結節患者作為研究對象，按隨機數字表法分為觀察組與對照組，每組各46例。對照組給予超聲引導下射頻消融治療，觀察組給予超聲引導下微波消融治療，記錄兩組治療效果。 結果 所有患者都順利完成消融，治療后觀察組與對照組的消融總有效率分別為87.0%和82.6%，差異無統計學意義（P > 0.05）。觀察組與對照組治療后3 d的肝功能損害發生率分別為4.3%和17.4%，觀察組肝功能損害發生率低于對照組（P < 0.05）。觀察組與對照組治療后14 d的血清總三碘甲腺原氨酸（TT3）、總甲狀腺素（TT4）值明顯高于治療前（P < 0.05），同時治療后14 d觀察組的血清TT3與TT4值明顯高于對照組（P < 0.05）。觀察組治療后3個月的并發癥發生率為6.5%，對照組為26.1%，觀察組明顯低于對照組（P < 0.05）。 結論 超聲引導下微波消融治療甲狀腺良性結節也具有很好的消融效果，能促進甲狀腺激素分泌正常，減少對肝功能的損傷，降低并發癥的發生，有很好的應用價值。

[關鍵詞] 射頻消融；超聲；微波消融；甲狀腺良性結節

[中圖分類號] R445.1 [文獻標識碼] A [文章編號] 1673-7210（2018）03（a）-0123-04

[Abstract] Objective To discuss the comparative values of radiofrequency ablation and microwave ablation in the treatment of benign thyroid nodules. Methods From August 2013 to January 2017， 92 patients with benign thyroid nodules in Tangshan People's Hospital were selected and divided into observation group and control group by random number table， with 46 cases in each group. The control group was treated by ultrasound guided radiofrequency ablation therapy， and the observation group was treated by ultrasound guided microwave ablation treatment. The prognosis in the two groups were recorde. Results All patients were completed the ablation successfully. After treatment， the total effective rates of the observation group and the control group were 87% and 82.6% respectively， and there was no significant difference compared between the two groups （P > 0.05）. Three days after treatment， incidence rates of hepatic dysfunction in observation group and control group were 4.3% and 17.4% respectively， and the incidence of the observation group was lower than that of the control group （P < 0.05）. Fourteen days after treatment， the serum TT3 and TT4 values of the observation group and the control group were significantly higher than before treatment （P < 0.05）， and the values of the observation group were higher than those of the control group （P < 0.05）. Three months after treatment， the total complication incidence rate in the observation group was 6.5%， 26.1% in the control group， so the observation group was significantly lower than the control group （P < 0.05）. Conclusion Compares with ultrasound guided radiofrequency ablation， microwave ablation of benign thyroid nodules has good ablation effect. It can promote thyroid hormone secretion， reduce liver damage， reduce the incidence of complications， and it has very good application values.

[Key words] Radiofrequency ablation； Ultrasound； Microwave ablation； Benign thyroid nodules

超聲引導下微波消融治療甲狀腺良性結節具有很好的消融效果，能促進甲狀腺激素分泌正常，減少對肝功能的損傷，降低并發癥的發生，有很好的應用價值[1-2]。甲狀腺是人體內重要的內分泌腺體，甲狀腺結節是一種臨床常見病。流行病學調查顯示我國人群中甲狀腺結節的發病率為4%左右，女性發病率高于男生，其中90%以上為良性結節[3-4]。循證醫學證據表明有些甲狀腺良性結節存在癌變的潛能，為此需要進行早期治療[5-6]。目前對于甲狀腺良性結節的主要治療方法為手術治療、藥物治療等，但是都有一定的缺陷。熱消融作為替代外科手術治療甲狀腺良性結節的創新治療方式，能有效地減少結節的容積[7]。該技術是在超聲引導下通過高溫加熱作用（微波、射頻）引起病灶組織發生凝固性壞死，從而達到微創局部滅活病灶的目的[8-9]。射……