| Research background and purpose:Thyroid nodules are a common disorder,with prevalence rates of 5%for women and 1%for men in iodine-rich areas of the world.It can be detected by ultrasound in 20to 70 percent of the general population.Thyroid nodules can be divided into cystic,solid and mixed.According to the number can be classified as single,multiple.Benign thyroid nodules are relatively common,malignant rate of about 5%.Treatment is necessary even if most thyroid nodules are benign,especially subjective symptoms,cosmetic problems,and the fear of malignant transformation.The traditional surgery and conservative treatment have shortcomings,now operation method is mainly By The Neck Resection Of Thyroid,Transoral Thyroidectomy,Endoscopic Thyroidectomy,although the effect of surgical treatment for sure,but it may cause some problems,such as long-term hospitalization,upper respiratory tract obstruction,neck scar,laryngeal recurrent nerve injury,iatrogenic hypothyroidism need lifelong medication,difficulty and the risk of general anesthesia surgery again.Thyroid hormone suppression therapy has a very limited effect on thyroid tumor shrinkage,often resulting in subnormal levels of serum thyroid hormone(TSH).Radioactive iodine is used for the treatment of thyroid autonomous high function adenoma and the adjuvant treatment of thyroid cancer after surgery.Patients with this type of benign nodules are often accompanied by hyperthyroidism before treatment and are at risk of hypothyroidism after treatment.Ultrasound-guided minimally invasive ablation has the advantages of simple operation,short treatment time and low treatment cost.Therefore,ultrasound-guided minimally invasive ablation has attracted clinical attention.At present,minimally invasive ablation of benign thyroid nodules mainly includes:Ethanol Ablation(EA),Laser Photocoagulation(LAT),Radiofrequency Ablation(RFA),High Intensity Focused Ultrasound(HIFU),and Microwave Ablation(MWA).MWA is a new type of local thermal ablation technology,which has the advantages of fast heating speed,strong coagulation ability and large ablation range,the present stage,it has become an important method for the treatment of thyroid nodules.But there are few relevant clinical studies and previous reports have limitations,such as a small sample size and a lack of thyroid function monitoring and pathological evaluation during follow-up.Therefore,microwave ablation as a new method for thyroid nodule therapy needs further research and exploration.In this study,we use the fine needle biopsy guided by ultrasound(FNAB)determine thyroid benign tumor before ablation,it was treated by microwave ablation.After treatment to determine the changes of tumor volume and the changes of thyroid function,postoperative incision aesthetics score and pain score,postoperative complications,and postoperative core needle biopsy were determined to observe the tissue necrosis in the ablation area.To evaluate its efficacy of microwave ablation on different properties and different sizes of nodules.Compared with the patients undergoing traditional surgery at the same time,incision beauty score and pain score were compared,and the histopathology of the ablation area was dynamically evaluated.It provides more effective evidence for the application of this method in clinical practice.Objective:To investigate the clinical effect of ultrasound-guided microwave ablat ion of benign thyroid tumors(WMA),the effect of microwave ablation on nodul es of different properties and sizes,and the dynamic changes of postoperative hi stopathology.Materials and MethodsA total of 75 nodules were included in 57 patients with benign thyroid tumors who underwent ultrasound guided microwave ablation in our hospital from January 2018 to January 2019.During the same period,57 patients with benign thyroid tumors underwent conventional surgical treatment.Before treatment,thyroid function was routinely detected,the size of the tumor was measured,blood perfusion of the tumor was determined by CEUS,vascular distribution of the tumor was evaluated by Doppler Ultrasound,and needle aspiration biopsy was performed on all lesions.After treatment,patients were followed up for 1,3,6 and 12 months to observe and record the reduction rate of thyroid nodule volume,changes in thyroid function and occurrence of complications.Immediately after the treatment,CEUS was performed to evaluate the tumor vessel ablation and ablation completion rate.The efficacy was evaluated through the changes of various indexes and complications,the incision aesthetic score and pain score were compared with those of patients undergoing thyroid surgery at the same time.75,15,12,20,13 ablation areas were successfully obtained from patients who received core needle biopsy for immediately,1 month,3 months,6 months and 12 months after the ablation(each patient was only sampled once at different follow-up times).Then routine H-E staining was performed to observe the histopathological morphology and structure of ablation areas at different follow-up times and evaluate the dynamic changes of postoperative histopathology.Result1.Comparison of efficacy and complications after microwave ablationVRR was 41%,52%,74%and 69%,respectively.The mean volume was 2.13±2.42 cm~3 before treatment and 0.65±0.90 cm~3 at the 12-month follow-up.The average volume reduction rate was 5.7%.During the treatment,all patients were well tolerated,1patient suffered minor skin burn postoperative,pain in 6 patients,swelling in 3 patients,hoarseness in 2 patients,and no serious complications after treatment.2.Thyroid functionMicrowave ablation surgery can cause damage to thyroid tissue and thyroid nodules,only 1 case of postoperative patients experienced transient hypothyroidism,all the rest of the line of microwave ablation surgery postoperative thyroid function in patients with no obvious change,no clinical symptoms,no significant difference before and after ablation surgery,the result has no statistical significance(P>0.05).3.Comparison of the effect of microwave ablation on nodules of different properties and sizesThere was a statistical difference in the effect of microwave ablation on solid,cystic and mixed nodules.The volume reduction rate of cystic nodules was significantly higher than that of solid nodules and mixed nodules,and the results were statistically significant(P<0.05).The nodules in the group<20mm diameter and the group20-40mm diameter decreased significantly in volume at 1 month follow-up compared with the other group,and the nodules in the group<20mm diameter decreased most significantly at 6 months,while there was no significant difference in volume during the rest of the follow-up.4.Subjective symptom evaluation of patientsCompared with the patients who underwent thyroid surgery to remove benign tumors at the same time,the incision beauty score and pain score could be found that the microwave ablation group was superior to the thyroid surgery group in terms of aesthetic appearance and pain score,and the difference was statistically significant(P<0.05).5.Postoperative histopathological dynamic changesAt the ablative power of 30W,75,15,12,20,13 nodules were obtained,respectively at once and 1,3,6,12 months after ablation.75 nodules were collected by core needle biopsy immediately after the surgery,and no necrosis was found in the ablation area,only coagulation degeneration,ten nodules were followed up for 1 month with complete necrosis,10 for 3 months with complete necrosis,20 for 6 months with complete necrosis,and 13 for 12 months with complete necrosis.ConclusionsIn conclusion,the volume of ultrasound guided microwave ablation in the treatment of benign thyroid tumors decreased significantly,no adverse complications were observed,and the treatment was well tolerated.The effect seems to be definite for cystic tumors,and the volume of nodules of different sizes gradually decreases with time after ablation,with the most significant effect at 6 months.The most serious complication of microwave ablation is nerve injury,but as long as the practice is strictly standardized and the mobile ablation technique is adopted,incomplete ablation of adjacent nerve tumors can be considered and the incidence will be significantly reduced by experienced thyroid surgeons.Histopathological changes suggested that the good effect of microwave ablation on thyroid nodules was due to complete cell necrosis.Microwave ablation for benign thyroid tumors is better than surgery in terms of incision aesthetics and pain score,and can be used as a new treatment method when patients meet the indications. |
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