[1]邱秀萍,张 婷,陈 阳,等.射频消融术在弥漫性毒性甲状腺肿中的应用[J].介入放射学杂志,2023,32(09):871-874.
 QIU Xiuping,ZHANG Ting,CHEN Yang,et al.Application of radiofrequency ablation in treating diffuse toxic goiter[J].journal interventional radiology,2023,32(09):871-874.
点击复制

射频消融术在弥漫性毒性甲状腺肿中的应用()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
32
期数:
2023年09
页码:
871-874
栏目:
非血管介入
出版日期:
2023-09-27

文章信息/Info

Title:
Application of radiofrequency ablation in treating diffuse toxic goiter
作者:
邱秀萍 张 婷 陈 阳 黄汝哨 王 炜 陈杭菊 邱思花 涂 梅
Author(s):
QIU Xiuping ZHANG Ting CHEN Yang HUANG Rushao WANG Wei CHEN Hangju QIU Sihua TU Mei.
Department of Endocrinology, Longyan Municipal First Hospital, Longyan, Fujian Province 364000, China
关键词:
【关键词】 射频消融 弥漫性毒性甲状腺肿 甲巯咪唑
文献标志码:
A
摘要:
【摘要】 目的 探讨超声引导下射频消融(RFA)治疗弥漫性毒性甲状腺肿(Graves病)的疗效。方法 纳入20例Graves病患者,超声引导下行RFA术,将甲状腺近全消融,仅保留甲状腺危险三角处2~3 mm。比较术后1、3 h疼痛视觉模拟量表(VAS)评分;术后1、3、6、12个月复查甲状腺功能、甲状腺彩超,计算甲状腺体积、甲巯咪唑用量。结果 20例Graves病患者的年龄为(36.4±9.2)岁,病程为(7.10±1.57)年,术前甲状腺体积为(38.14±8.19) cm3, 术前甲巯咪唑用量为(9.50±2.23) mg。术后1年7例患者停药,停药者术前TRAb<10 IU/L,甲状腺体积为(30.14±4.19) cm3。术后随着时间延长,甲状腺体积、TRAb、甲巯咪唑用量逐渐减少。术后1年甲状腺体积和TRAb与1年后甲巯咪唑用量呈正相关。20例患者中,治疗有效18例,2例术后1年FT3、FT4、TSH仍异常,甲巯咪唑用量较术前无减量。冰敷组VAS评分为2~3分,非冰敷组为2~5分。术后1 h冰敷组VAS评分秩平均值为6.1,非冰敷组为14.9(Z=-3.50,P<0.01);术后3 h分别为8.5和12.5(Z=-1.78,P=0.075)。不良反应主要是疼痛、颈部肿胀、声音嘶哑。结论 超声引导下RFA治疗Graves病不良反应小,疗效显著,部分患者仍需小剂量抗甲亢药物维持,TRAb<10 IU/L、甲状腺体积较小者有望停药。

参考文献/References:

[1] Norsworthy GD, Carney HC, Ward CR. 2016 AAFP guidelines for the management of feline hyperthyroidism[J]. J Feline Med Surg, 2016, 18: 750.
[2] Zhi X, Zhao N, Liu Y, et al. Microwave ablation compared to thyroidectomy to treat benign thyroid nodules[J]. Int J Hyperthermia, 2018, 34: 644- 652.
[3] Baek JH, Lee JH, Valcavi R, et al. Thermal ablation for benign thyroid nodules: radiofrequency and laser[J]. Korean J Radiol, 2011, 12: 525- 540.
[4] 杜小梅,李明锐,吴让兵,等. 超声引导下微波消融治疗难治性甲亢临床疗效[J]. 中国医学物理学杂志, 2019, 36:697- 700.
[5] 陈建发,杨雪丰,陈引香,等. 超声引导下经皮穿刺微波消融术治疗Graves病30例效果观察[J]. 广东医科大学学报, 2017,35:528- 531.
[6] 中国医师协会外科医师分会甲状腺外科医师委员会,中国研究型医院学会甲状腺疾病专业委员会,中国医疗保健国际交流促进会临床实用技术分会.甲状腺功能亢进症外科治疗中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40:1229- 1233.
[7] 邱秀萍,温石娣,陈 阳,等. 超声引导下甲状腺热消融术疼痛的影响因素[J]. 介入放射学杂志, 2022, 31:797- 800.
[8] 李淑文,刘 进,刘月晅. 甲巯咪唑对甲状腺功能亢进症患者甲状腺激素及甲状腺体积的影响[J]. 临床和实验医学杂志,2022, 21:371- 374.
[9] Masiello E,Veronesi G,Gallo D,et al. Antithyroid drug treatment for Graves’ disease: baseline predictive models of relapse after treatment for a patient- tailored management[J]. J Endocrinol Invest, 2018, 41: 1425- 1432.
[10] Azizi F, Malboosbaf R. Long- term antithyroid drug treatmet: a systematic review and meta- analysis[J]. Thyroid, 2017, 27: 1223- 1231.
[11] Azizi F, Amouzegar A, Tohidi M, et al. Increased remission rates after long-term methimazole therapy in patients with Graves’ disease: results of a randomized clinical trial[J]. Thyroid, 2019, 29: 1192- 1200.
[12] 闰利英,李随勤,施秉银,等. 甲状腺功能亢进症的外科治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41:595- 598.
[13] 中国医师协会介入医师分会超声介入专业委员会,中国医师协会介入医师分会肿瘤消融治疗专业委员会,中国医师协会甲状腺肿瘤消融治疗技术专家组,等. 原发性甲状腺功能亢进症热消融治疗专家共识及操作规范(2022年版)[J]. 中华内科杂志, 2022, 61:507- 516.
[14] Shi H, Sheng RR, Hu YF, et al. Risk factors for the relapse of graves’ disease treated with antithyroid drugs: a systematic review and meta- analysis[J]. Clin Ther, 2020, 42: 662- 675.e4.
[15] Kotwal A, Stan M. Thyrotropin receptor antibodies: an overview[J]. Ophthalmic Plast Reconstr Surg, 2018, 34: S20- S27.
[16] 雷 爽,徐红霞. 改良型加压冰敷袋对成人踝关节骨折术前患肢肿胀及疼痛程度的影响[J]. 实用医院临床杂志, 2022, 19:29- 32.

相似文献/References:

[1]董雪迎,周显礼. 超声引导下射频消融对甲状腺占位性病变治疗的研究进展[J].介入放射学杂志,2012,(05):433.
 . Radiofrequency ablation under ultrasonic guidance for the treatment of thyroid spaceoccupying lesions: recent progress in research[J].journal interventional radiology,2012,(09):433.
[2]侯明明,胡继红,赵 卫,等.经皮射频消融治疗门静脉高压性脾功能亢进的临床研究[J].介入放射学杂志,2014,(10):889.
 HOU Ming ming,HU Ji hong,ZHAO Wei,et al.Percutaneous radiofrequency ablation for the treatment of hypersplenism due to portal hypertension: a clinical study[J].journal interventional radiology,2014,(09):889.
[3]王 凇,翁 勰,龚 伟,等. 热敏脂质体抗肿瘤药物改善肝肿瘤热消融疗效的动物实验[J].介入放射学杂志,2014,(06):506.
 WANG Song,WENG Xie,GONG Wei,et al. Using thermosensitive chemotherapy agent to improve the effect of radiofrequency ablation for liver tumors: an animal experiment[J].journal interventional radiology,2014,(09):506.
[4]翁 勰,王 凇,陈敏华,等. 肝癌射频消融后液气胸伴皮下气肿一例[J].介入放射学杂志,2014,(06):554.
 WENG Xie,WANG Song,CHEN Min- hua,et al. Hydropneumothorax associated with subcutaneous emphysema cause by radiofrequency ablation for liver cancer: report of one case[J].journal interventional radiology,2014,(09):554.
[5]石华铮,刘士远,朱海云,等.PET/CT及DWI MRI早期评估兔VX2肉瘤射频消融效果[J].介入放射学杂志,2015,(03):243.
 SHI Hua zheng,LIU Shi yuan,ZHU Hai yun,et al.FDG PET/CT and diffusion weighted MRI evaluation of the early therapeutic effect of radiofrequency ablation for VX2 sarcomas in rabbits[J].journal interventional radiology,2015,(09):243.
[6]韩景奇,张传玉,李 涌,等.早期非小细胞肺癌CT引导射频消融治疗60例临床分析[J].介入放射学杂志,2015,(05):414.
 HAN Jing qi,ZHANG Chuan yu,LI Yong,et al.CT guided radiofrequency ablation for the treatment of early stage non small cell lung cancer: clinical analysis of 60 cases[J].journal interventional radiology,2015,(09):414.
[7]刘宝东,胡 牧,刘 磊,等.射频消融联合表皮生长因子受体酪氨酸激酶抑制剂治疗表皮生长因子受体突变非小细胞肺癌的临床价值 [J].介入放射学杂志,2018,27(11):1036.
 LIU Baodong,HU Mu,LIU Lei,et al.Radiofrequency ablation combined with EGFR- TKIs for EGFR mutant non- small cell lung cancer: its clinical application[J].journal interventional radiology,2018,27(09):1036.
[8]朱晓红,王 芳,刘宝东.82例老年肺癌患者射频消融术后随访调查分析 [J].介入放射学杂志,2018,27(11):1095.
 ZHU Xiaohong,WANG Fang,LIU Baodong..Follow- up investigation and analysis of 82 elderly patients with lung cancer after radiofrequency ablation[J].journal interventional radiology,2018,27(09):1095.
[9]王东东,李晓光.肝癌射频消融后肿瘤残余的研究现状与进展[J].介入放射学杂志,2019,28(08):800.
 WANG Dongdong,LI Xiaoguang..Residual tumor after radiofrequency ablation of hepatocellular carcinoma: its current situation and research progress[J].journal interventional radiology,2019,28(09):800.
[10]吴林霖,施一翔,刘敬禹,等.超声引导与CT引导原发性肝癌射频消融对比分析 [J].介入放射学杂志,2019,28(12):1162.
 WU Linlin,SHI Yixiang,LIU Jingyu,et al.US- guided versus CT- guided radiofrequency ablation for HCC: comparison of curative effects[J].journal interventional radiology,2019,28(09):1162.

备注/Memo

备注/Memo:
(收稿日期:2022- 09- 18)
(本文编辑:新 宇)
更新日期/Last Update: 2023-09-26