The Clinical Research About Ultrasound-guided Laser Ablation Of Papillary Thyroid Carcinoma

Objective: 1.To obtain parameters of laser ablation(LA)on human thyroid and observe the pathologic changes of the ablated area in vitro to facilitate the clinical applications.2.To evaluate the therapeutic effect and clinical significance of ultrasound-guided percutaneous laser ablation using in papillary thyroid micro-carcinoma.3.To evaluate the therapeutic effect and clinical significance of ultrasound-guided percutaneous laser ablation using in cervical lymphnodes metastasis of PTCs.Methods: 1.LA was performed in 21 pieces of the resected human thyroid tissue in vitro with different power output and energy.The shape and size(longest and shortest axis dimensions)of ablated area,LA duration,and pathologic changes were observed.2.A total of 70 cases,from December 2013 to December 2016,were confirmed as PTMCs or tended to be PTMCs by US-FNAB.All patients requested percutaneous laser ablation voluntarily.After the risk and possible complications of percutaneous laser ablation sufficiently explained,they were asked to sign the informed contents.The treatment time,energy,and symptoms in operation were recorded,then using contrast enhanced ultrasound to access the results.During the follow-up period,patients who were treated by percutaneous laser ablation would be visited,the follow-up contents included the change of the ablation area volume,thyroid function,postoperative symptoms and complications,recurrence and metastasis and postoperative biopsy.3.A total of 46 cases,from December 2013 to December 2016,were confirmed as cervical lymphnodes metastasis of PTCs by US–FNAB.All patients requested percutaneous laser ablation voluntarily.After the risk and possible complications of percutaneous laser ablation sufficiently explained,they were asked to sign the informed contents.The treatment time,energy,and symptoms in operation were recorded,then using contrast enhanced ultrasound to access the results.During the follow-up period,patients who were treated by percutaneous laser ablation would be visited,the follow-up contents included the change of the ablation area volume,serum Tg,postoperative symptoms and complications,recurrence and metastasis and postoperative biopsy.Results: 1.The ablation area was excellent uniformity and its shape was spherical.Three distinct zones of the ablated area were identified as a gasification and needle path,a ablation zone,and a region near to the ablated zone.Microscopically,coagulation necrosis and cellular destruction with nuclear distortion,shrinkage and fragmentation were seen in the ablation zone.2.Ultrasound-guided PLA to papillary thyroid micro-carcinomas is feasible.In the process of the treatment,there were no other symptoms except painfulness.After percutaneous laser ablation,no serious complications had been observed,the volume of ablation area shrinked gradually.No recurrence and metastasis were observed in the follow-up periods(the longest up to 36 months after ablation).3.Ultrasound-guided PLA to cervical lymphnodes metastasis of PTCs is feasible.In the process of the treatment,there were no other symptoms except painfulness.After percutaneous laser ablation,no serious complications had been observed,the volume of ablation area shrinked gradually,which was completely disappeared or scar-like residual.S-Tg turned to be undetected(<0.02ng/ml)during the patients with detected s-Tg(>0.02ng/ml)before PLA.No recurrence and metastasis were observed in the follow-up periods(the longest up to 36 months after ablation).Conclusions: 1.LA can get a spherical ablation shape and lead to a rapid coagulation necrosis in human thyroid tissue in vitro.2.Ultrasound-guided PLA to papillary thyroid micro-carcinomas is feasible,effective and safe.3.Ultrasound-guided PLA to cervical lymphnodes metastasis of PTCs is feasible,effective and safe.