“液体隔离带”法微波消融治疗高风险甲状腺良性结节的有效性和安全性观察

目的　探讨在超声引导下注射“液体隔离带”后微波消融治疗高风险甲状腺良性结节患者的临床有效性和安全性。 方法　选取2017年7月至2018年5月在南方医院超声引导下注射“液体隔离带”后行经皮微波消融术治疗高风险甲状腺良性结节的患者。手术前、术后6个月评估结节长径、体积、体积缩小比例及其它相关临床表现，包括美容和症状评分，甲状腺功能和相关抗体。同时随访患者术中、术后并发症，如牙痛，声嘶，吞咽困难等。 结果　入选随访资料完整患者54例（女性49例，男性5例），平均年龄（44.6±11.85）岁（20~66岁）。初始结节平均长径（2.90±1.18）cm，6个月后（1.90±0.94）cm，显著缩小（P＜0.001）。初始结节体积为（7.81±8.76）mL，末次随访时（2.66±3.23）mL，显著缩小（P＜0.001），平均体积缩小（69.65±15.27）%。症状和美容评分均降低，P＜0.001。术中牙痛2例，停止消融后牙痛缓解。1例消融后声音嘶哑，未予处理，1月后声音恢复。术中出血1例。无患者诉术后吞咽困难。 结论　超声引导下注射“液体隔离带”后行经皮微波消融术可改善高风险良性甲状腺患者的外观问题和症状，并具有较高的安全性。

Effectiveness and safety of microwave ablation with "liquid isolation zone" in the treatment of high risk benign thyroid nodules

Objective　To investigate the clinical efficacy and safety of ultrasound-guided microwave ablation in the treatment of high-risk benign thyroid nodules.　Methods　From July 2017 to May 2018, patients with high-risk benign thyroid nodules underwent percutaneous microwave ablation after ultrasound-guided injection of "liquid sequestration belt". Prior to surgery and 6 months after surgery, the length, volume, volume reduction ratio and relevant clinical manifestations of nodules were assessed, including cosmetic and symptomatic scores, thyroid function and thyroid-related antibodies. At the same time, the complications such as toothache, hoarseness and dysphagia were followed up. Results A total of 54 patients (49 females and 5 males) with complete follow-up data were enrolled, with an average age of (44.6±11.85) years (20~66 years). The average length and diameter of the initial nodule were (2.90±1.18) cm and decreased significantly to (1.90±0.94) cm after 6 months(P<0.001). The initial nodule volume was (7.81±8.76) mL and significantly decreased to (2.66±3.23) mL at the last follow-up( P<0.001), with an average reduction of (69.65±15.27)%. The scores of symptoms and cosmetology decreased (P<0.001). There were 2 cases of toothache during the operation. The toothache was relieved after stopping ablation. One case had hoarseness after ablation, but no treatment was given. The voice recovered after 1 month. Intraoperative bleeding occurred in one cases. No patients developed dysphagia. Conclusion Ultrasound-guided percutaneous microwave ablation after injection of "liquid isolation zone" can improve the appearance and symptoms of high-risk benign thyroid patients, and ensure the safety of surgery.