| Objective The purpose of this study was to investigate ultrasound guided radiofrequency ablation treatment efficacy and safety of papillary thyroid microcarcinoma,accumulate in the process of research and analysis of the collected data,to explore the change rule of the treatment process,improve the technology,promote the technology matures and applications.At the same time in our hospital of surgical treatment of papillary thyroid microcarcinoma lymph node metastasis in statistics,analysis of minor risk factors for papillary microcarcinoma lymph node metastasis,improve melting indications,let melting technology more standardized and reasonable applied to clinical,benefit the patients.Methods A retrospective analysis of July 2015 to December 2016,in the center of the group,Hangzhou no.1 hospital tumor minimally invasive interventional and special survey of hospital of Hangzhou xixi hospital interventional diagnosis and treatment center of ultrasound guided radiofrequency ablation treatment of 36 cases of thyroid papillary carcinoma patients,a total of 36 lesions,nodal diameter less than 1 cm,preoperative biopsy guided by ultrasound in cytology of papillary thyroid microcarcinoma,preoperative conventional ultrasound and enhancement CT neck lymph nodes were not found abnormal enlargement.A total of 36 lesions in 36 patients after radiofrequency ablation,immediately after ablation,1 month,3 months,6 months and 12 months follow-up,regularly use conventional two-dimensional ultrasound and ultrasound imaging of lesion size and presence of recurrence after ablation,and so on and so forth to evaluate and record,melting and thyroid function tests before and after any change records,6 months and 12 months after RFA to review the neck CT screening with and without lymph node metastasis,and so on and so forth.At the same time,the lymph node metastasis of 155 cases of papillary thyroid microcarcinoma treated in our hospital during the same period was counted and the related risk factors were analyzed and summarized.Statistical software of SPSS20.0 was used to analyze the data.Result 1.36 patients,mean age 44.3±9.6 years old,a total of 36 lesions enlarge the radiofrequency ablation,operation time 40-60S,postoperative immediate contrast-enhanced ultrasound examination were not found residual lesions,one-time complete ablation rate was 100%.2.In the 36 patients,5 patients had obvious pain in the operation,which reduced the ablation power,and the postoperative operation was performed after the pain relief of the liquid isolation belt.The results were performed successfully.1 case of postoperative tissue swelling,consider for the gland hemorrhage,to press and ice compress after 30 min every 10 min observation time,glandular lobe volume did not continue to increase,and the next day after three days to ultrasonic review,gland gradually returned to preoperative size.One patient had a hoarseness and emerged the next day after RFA,and recovered a week later.3.Before radiofrequency ablation,thyroid function in patients with routine inspection,36 patients TT3,TT4,FT3,FT4,TSH and PTH in the normal range,a week or so to review the thyroid function after thermal ablation,3 cases of 36 cases occur TSH decreased,but nobody have obvious clinical symptoms,ask client to check regularly,after one month back to normal.4.Volume of the lesions were 0.006-0.234ml before ablation,average volume was 0.071±0.058 ml,expand ablation after focal average volume of 0.358±0.203ml,ablation after 1 month,3 months,6 months and 12 months average focal ablation volume was 0.200±0.120 ml,0.071±0.060 ml and 0.060±0.034 ml and 0.011±0.009 ml,the average rate was 44.3±10.6%smaller,81.7±9.1%,93.9±5.8%,97.8±1.6%,the difference had statistical significance(P<0.05).3 months after ablation 1 lesion disappeared,6 months,11 cases of lesions disappeared,29 lesions disappeared after 12 months,to 18 months follow-up when only 1 case of ablation in patients with focal not completely disappear(melting residual volume is about 0.006 ml)oven.No lymph node metastasis was found in conventional ultrasound and cervical enhancement CT.5.155 surgical cases,9 cases of preoperative CT prompted the neck lymph node enlargement(including 3 cases of conventional ultrasound tip lymph node enlargement,more than 6 cases of conventional ultrasound found no enlarged lymph nodes),swollen lymph nodes are not found in 146 cases of preoperative imaging.In 155 cases,all patients underwent thyroidectomy or total resection,unilateral or bilateral central lymph node dissection.Postoperative pathologic findings were found in 39 patients with lymph node metastasis,with a incidence of 25.2%(39/155).The preoperative 9 cases showed metastatic metastasis in the lymph nodes of the enlarged lymph nodes.6.In 155 cases of PTMC,122 patients with unilateral single lesion were isolated,27 cases were metastasized in the central region,and the incidence rate was 22.1%(27/122).Among the 33 patients with multiple lesions,12 showed lymph node metastasis,with a rate of 36.4%.130 cases of female patients,28 cases of lymph node metastasis,the incidence was 21.5%(28/130).There were 25 cases of male and 11 cases of lymph node metastasis,with an incidence of 44%(11/25).80 cases of<45Y patients,31 cases of central lymph node metastasis,the incidence rate was 38.8%(31/80),75 patients with≥45Y,and 8 cases of lymph node metastasis in the central region.The incidence rate was 10.7%(8/75).There were 80 cases of>5mm carcinomas and 25 cases of lymph node metastasis,the incidence rate was 31.3%(25/80).There were 75 cases and 14 cases of lymph node metastasis,the incidence rate was 18.7%(14/75).Carcinomas were closely related to the membrane of 31 cases,16 cases showed lymph node metastasis,and the incidence rate was 51.6%(16/31),the margin of cancer was more than 124 cases of the membrane,and the lymph node metastasis of 23 cases was 18.5%(23/124).The single factor analysis showed that the lymph node metastasis in the central area was significantly correlated with the age of the patient,male or female and whether the film was involved(P<0.05).Binomial Logistic regression analysis showed that patients with age(OR=1.853,P=0.000),the number of cancer(OR=1.122,P=0.031)and whether the lesions involving envelope(OR=1.699,P=0.000)independent risk factors for metastasis of lymph node in central region.Conclusion Ultrasound guided papillary thyroid microcarcinoma radiofrequency ablation treatment the short-term effect is clear,safe treatment process,to avoid the surgical trauma and incision scar,and effective to keep the patient’s thyroid function,avoid long-term medication."Liquid isolation belt method" can effectively prevent the damage of peripheral important structures caused by radiofrequency ablation,and it is easy to operate and has high clinical value.Ultrasonography is an effective method to evaluate the radiofrequency ablation of papillary thyroid microcarcinomas.It can be used to determine the range of preoperative lesions,whether there is residual in the operation,or whether there is a recurrence of the lesion after RFA.Of papillary thyroid microcarcinoma with lymph node metastases of case is not rare,selected cases should be strictly grasp the indications,sufficient to assess risk factors,can effectively reduce the worries of postoperative lymph node metastases. |
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