CAJ | 학술논문

目的建立经皮射频消融治疗甲状腺腺瘤的方案,探讨其技术特征、方法步骤、安全性及疗效评价手段.方法使用Celon-ProBreath双极式射频电极针在高频超声引导和超声造影监测下对甲状腺腺瘤进行经皮穿刺消融,就消融适应证、最佳穿刺路径、麻醉方式、保护重要血管和喉返神经、减少活检出血、判断消融彻底性以及终止消融的指征等进行探索与解析.结果腺瘤最大直径＜20 mm为最佳适应证;依腺瘤的解剖位置穿刺路径J选择从颈外侧向内侧穿刺或从颈中线经甲状腺峡部向外侧穿刺;需对甲状腺包膜四周间隙尤其是前包膜与后包膜处进行局部麻醉;"液体隔离带"法可保护颈总动脉和喉返神经免受刺伤与热损伤;对血供丰富的腺瘤先阻断其滋养动脉再穿刺切割活检可明显减少出血;多点多平面逐步消融可提高凝固的全面性和彻底性;超声造影示消融区无增强是终止消融的重要指征.结论本研究所阐述的穿刺方法、技术要点与超声造影监测令甲状腺腺瘤射频消融安全、可行,效果可靠,创伤更加轻微.
목적 건립경피사빈소융치료갑상선선류적방안,탐토기기술특정、방법보취、안전성급료효평개수단.방법 사용Celon-ProBreath쌍겁식사빈전겁침재고빈초성인도화초성조영감측하대갑상선선류진행경피천자소융,취소융괄응증、최가천자로경、마취방식、보호중요혈관화후반신경、감소활검출혈、판단소융철저성이급종지소융적지정등진행탐색여해석.결과 선류최대직경＜20 mm위최가괄응증;의선류적해부위치천자로경J선택종경외측향내측천자혹종경중선경갑상선협부향외측천자;수대갑상선포막사주간극우기시전포막여후포막처진행국부마취;"액체격리대"법가보호경총동맥화후반신경면수자상여열손상;대혈공봉부적선류선조단기자양동맥재천자절할활검가명현감소출혈;다점다평면축보소융가제고응고적전면성화철저성;초성조영시소융구무증강시종지소융적중요지정.결론 본연구소천술적천자방법、기술요점여초성조영감측령갑상선선류사빈소융안전、가행,효과가고,창상경가경미.
Objective To establish a treatment proposal of thyroid adenoma by using percutaneous radiofrequency ablation(RFA) and investigate its techniques and skills, means and steps, and safety and efficacy. Methods Contrast-enhanced ultrasound-guided percutaneous RFA of thyroid adenomas were conducted on 202 patients by using an auto-controlled bi-polar electrode system. The indications of thyroid RFA,the optimal puncture route,the ways of anesthesia administration, protection of vital neck vessels and recurrent laryngeal nerve(RLN) and reduction of bleeding from core biopsy, indicators of ending ablation procedure following a complete ablation were investigated and analyzed. Resalts An adenoma smaller than 20 mm in maximal diameter was the optimal candidate for RFA. Either of two puncture routes could be selected upon the target lesion's location. Areas surrounding to the thyroid capsule needed adequate local anesthesia to kill pain. Liquid-isolating maneuver could effectively protect carotid artery and RLN from core needle cutting and electrode heating injury. Advanced block of supplying arteries with heating markedly reduced bleeding involved in the biopsy. Multipoint and multicenter ablation was essential to a complete coagulation. Filling-defect in the ablated adenoma on CEUS was the key sign to terminate ablation procedure. Conclusions Percutaneous bi-polar RFA was proved feasible, effective, safe and supermicroinvasive for treating thyroid adenoma under the way stated here of puncture and technical points and use of CEUS for monitoring.