CAJ | 학술논문

目的探讨超声引导甲状腺良性结节射频消融术前风险评估的意义及预防对策.方法 274例311个甲状腺良性实性结节治疗前根据消融风险由低到高分为0～Ⅳ级,其中0级38个,Ⅰ级69个,Ⅱ级36个,Ⅲ级59个,Ⅳ级109个.用连续移动法或多平面组合法消融,用“杠杆撬离法”或“液体隔离带法”预防热损伤毗邻结构.结果 311个甲状腺结节均完全消融.59个Ⅲ级风险结节中30个用“杠杆撬离法”均有效避免了热损伤;29个用“液体隔离带法”预防,2例发生喉返神经损伤,两种方法对Ⅲ级风险的预防效果比较差异无统计学意义(P=0.237).109个Ⅳ级风险结节中102个用“杠杆撬离法”、7个用“液体隔离带法”预防,发生喉返神经损伤分别有1例、2例,两种方法对Ⅳ级风险的预防效果比较差异有统计学意义(P=0.010).143个0～Ⅱ级风险结节消融时未损伤毗邻结构.结论甲状腺结节射频消融术前风险评估有助于并发症的预防.“杠杆撬离法”能有效预防热损伤毗邻结构,且操作简便,有一定的应用价值.
목적 탐토초성인도갑상선량성결절사빈소융술전풍험평고적의의급예방대책.방법 274례311개갑상선량성실성결절치료전근거소융풍험유저도고분위0～Ⅳ급,기중0급38개,Ⅰ급69개,Ⅱ급36개,Ⅲ급59개,Ⅳ급109개.용련속이동법혹다평면조합법소융,용“강간효리법”혹“액체격리대법”예방열손상비린결구.결과 311개갑상선결절균완전소융.59개Ⅲ급풍험결절중30개용“강간효리법”균유효피면료열손상;29개용“액체격리대법”예방,2례발생후반신경손상,량충방법대Ⅲ급풍험적예방효과비교차이무통계학의의(P=0.237).109개Ⅳ급풍험결절중102개용“강간효리법”、7개용“액체격리대법”예방,발생후반신경손상분별유1례、2례,량충방법대Ⅳ급풍험적예방효과비교차이유통계학의의(P=0.010).143개0～Ⅱ급풍험결절소융시미손상비린결구.결론 갑상선결절사빈소융술전풍험평고유조우병발증적예방.“강간효리법”능유효예방열손상비린결구,차조작간편,유일정적응용개치.
Objective To investigate the value of preoperative risk assessments and countermeasures on ultrasound-guided radiofrequency ablation for benign thyroid nodules.Methods The preoperative risk assessments of 311 benign solid thyroid nodules in 274 patients were divided into level 0-Ⅳ,among which 38 nodules on level 0,69 nodules on level Ⅰ,36 nodules on level Ⅱ,59 nodules on level Ⅲ,109 nodules on level Ⅳ.Treatments were performed by moving shot technique or multiplanar shot technique,using "Leverage Displacement" or "Hydrodissection" to prevent the adjacent vital structures from thermal injuries.Results 311 thyroid nodules were completely ablated.In ablating the 59 nodules on risk level Ⅲ,thermal injuries were effectively avoided in 30 cases by using "Leverage Displacement",while recurrent laryngeal nerve injuries happened in 2 cases using "Hydrodissection" for 29 nodules.The difference between these two methods on risk level Ⅲ had no statistical significance(P =0.237).To avoid thermal injuries during ablation for 109 nodules on risk level Ⅳ,using "Leverage Displacement" for 102 nodules,recurrent laryngeal nerve injuries happened in 1 case,while using "Hydrodissection" for 7 nodules,recurrent laryngeal nerve injuries happened in 2 cases.The difference between the two methods on risk level Ⅳ had statistical significance(P =0.010).No thermal injury happened during ablation for 143 nodules on risk level 0-Ⅱ.Conclusions Preoperative risk assessment on thyroid nodules is helpful in preventing potentially avoidable complications.Proper use of "Leverage Displacement" can protect adjacent vital structures from thermal injuries during ablation for nodules,which is easy and simple to handle and has a certain practical application value.