甲状腺微小乳头状癌经皮射频消融近期临床疗效观察

目的探讨超声引导下经皮射频消融治疗甲状腺微小乳头状癌的临床应用价值。方法选取经细针穿刺细胞学活检确诊的甲状腺微小乳头状癌患者19例，二维超声示单发病灶，最大切面2.4mm×3.0mm~8.0mm×8.9mm，均无淋巴结转移。超声引导下取18G射频针行定点消融，扩大消融范围，消融功率35~45W，单一消融点消融时间30~45s。详细记录术中及术后并发症，术后定期超声复查消融灶大小、有无复发病灶及淋巴结转移情况。结果19例甲状腺微小乳头状癌病灶均完全消融灭活，消融过程顺利。术中不适、术后局部隐痛等消融并发症发生率47.4%（9/19）。所有病灶均于术后18个月内完全消失，消融灶吸收呈“线”状回声。消融灶术后1、3、6、12个月平均缩小率分别为11.2%、45.6%、63.1%、82.3%。随访期间未见复发病灶及颈部淋巴结转移征象。结论超声引导下经皮甲状腺微小乳头状癌射频消融近期疗效显著，创伤小，安全性高，且不影响美观，值得临床上应用并进一步观察远期疗效。

Short-term efficacy of percutaneous radiofrequency ablation in treatment of thyroid papillary microcarcinoma

Objective To investigate the efficacy of percutaneous radiofrequency ablation in treatment of papillary thyroid microcarcinoma (PTMC). Methods Nineteen patients with PTMC diagnosed by fine needle aspiration were selected. The ultrasonography showed single lesions in all cases with the maximum section of 2.4mm ×3.0mm-8.0mm ×8.9mm and no metastatic lymph nodes. The ablation was guided by ultrasound, with a power of 35-45W and ablation time of 30-45s for a single lesion. The intraoperative and postoperative complications, size of the ablation site, recurrence and lymph nodemetastasis were documented. Results The procedures were successful and all 19 lesions were completely ablated. The complications, including intraoperative discomfort and postoperative local pain, occurred in 9 patients (47.4% ). All lesions completely disappeared within 18 months after procedure. The average reduction rates of lesions were 11.2%, 45.6%, 63.1%, 82.3% at 1, 3, 6, and 12 months after ablation, respectively. During the 18-month follow-up, no recurrence and cervical lymph node metastasis were found. Conclusion The short-term efficacy of ultrasound- guided percutaneous radiofrequency ablation for PTMC is satisfactory with noninvasiveness, safety and no adverse cosmetic effect, the long-term efficacy need to be confirmed.