Efficiency Analysis Of Ultrasound-guided Percutaneous Microwave Ablation In The Treatment Of Papillary Thyroid Microcarcinoma（T₁N₀M₀）

Research Background:There was a dramatic increase in the detection rate of PTMC in recent years with the progress of ultrasound technology,the development of puncture pathology and the increasing attention paid to thyroid diseases,but there was no significant change in the fatality rate.Currently,there is no uniform standard for the treatment of PTMC yet,so this issue has become a hot topic recently.On the one hand,surgery is still the first choice for the treatment of PTMC in the current medical environment in China.However,though the effect of surgery is good,there is the risk of over-treatment.On the other hand,the treatment could only be examining the focus regularly for the elderly who could not tolerate surgery and those with certain diseases who were unable to perform open surgery,for the fear of multiple surgeries,for poor tolerance to pain,or PTMC patients for fear of the aesthetic effects of postoperative cervical scars（especially PTMC for young women）and refuse surgery.Although the thyroid Micro-carcinoma has the characteristic of slow development where patients can coexist with the lesion for a long time,and some patients even have no symptoms for the life span,there is still a certain risk of lymph node metastasis.Therefore,it is urgent to find a minimally invasive method to treat PTMC.Ultrasound-guided percutaneous cold circulation microwave ablation has been paid to more attention because of its advantages of fewer traumas,faster recovery,less pain,shorter operation period and better cosmetic effect.At present,this technique has obtained remarkable curative effect in the treatment of liver malignant tumor and benign thyroid nodule,and wider experience has been gathered,but there are few reports on the treatment in PTMC.Purpose:We are going to explore the clinical application value of ultrasound-guided percutaneous cold circulatory microwave ablation in the treatment of PTMC（T₁N₀M₀）through 12-month follow-up observation of the changes of ablated focus size,echo,lymph node and distant metastasis,thyroid hormone and other aspects,such as whether there are lymph nodes and distant metastasis,or any effect on thyroid hormones,and so on.（T₁N₀M₀）.Method:Fifty-six patients（56 lesions）with thyroid function who were confirmed as PTMC（T₁N₀M₀）in our hospital from November 2015 to November 2016 are selected.Owing to many factors,patients refused traditional open surgery,but requested active treatment and voluntarily chose the microwave ablation surgery.The focus was evaluated before the operation.The volume of blood during the operation and Postoperative complications and the length of hospital stay were recorded.Then a group of standards were observed such as change of the focus,the shrinkage rate,the surrounding lymph node,distant metastasis and thyroid hormone.Finally,all data were summarized and analyzed.Result:1.The changes of lesion volume at month 1,3,6 and 12 after microwave ablation were recorded.The lesion volume reduction rates were-42.7%,10.5%,73.2%and 91.5%respectively.2.After microwave ablation,color Doppler and contrast-enhanced ultrasonography showed that the color flow signal in the normal gland without ablation was normal,but the blood flow signal in the ablation area was completely lost,and absolutely no contrast agent entered in.There was no recurrence of thyroid carcinoma and no abnormal peripheral lymph nodes after 12-month follow-up.3.All the patients had intraoperative bleeding of about 5 ml,and the hospitalization time was 3 days.No bleeding,hematoma and severe pain were found after operation.Only one patient developed hoarseness and recovered naturally within a week.One patient developed postoperative cough and the symptoms disappeared within two weeks without any drug control.4.The values of TSH before and after microwave surgery at month 1,3,6 and 12were recorded respectively as（mIU/mL）:2.22±1.01,2.22±1.10,2.31±1.06,2.34±1.12,2.23±1.11;The values of FT₃ were（pmol/L）:5.11±0.67,5.11±0.71,5.12±0.58,5.13±0.52,5.10±0.53;The values of FT₄ were（pmol/L）:15.5±1.41,15.1±1.11,15.1±1.01,14.8±1.05,15.3±1.11;The values of T₃ were（nmol/L）:2.27±1.03,2.23±1.01,2.28±1.02,2.30±1.03,2.25±1.00;The values of T₄ were（nmol/L）:107.8±35.9,108.9±33.8,109.1±34.5,107.3±33.9,108.3±34.6.Preoperative and postoperative TSH,FT₃,FT₄,T₃,T₄ values measured did not change significantly（P>0.05）.Conclusion:1.Ultrasound-guided microwave ablation is a minimally invasive,safe and effective method for the treatment of PTMC（T₁N₀M₀）.2.Compared with open surgery,microwave ablation can improve the quality of life of the patients without affecting the thyroid function and with less injury and complications.3.The treatment period is shorter,the pain is smaller,the recovery is faster,the cosmetic effect is better,and the satisfaction of the operation is higher.