摘要
目的 建立经皮射频消融治疗甲状腺腺瘤的方案,探讨其技术特征、方法步骤、安全性及疗效评价手段.方法 使用Celon-ProBreath双极式射频电极针在高频超声引导和超声造影监测下对甲状腺腺瘤进行经皮穿刺消融,就消融适应证、最佳穿刺路径、麻醉方式、保护重要血管和喉返神经、减少活检出血、判断消融彻底性以及终止消融的指征等进行探索与解析.结果 腺瘤最大直径＜20 mm为最佳适应证 依腺瘤的解剖位置穿刺路径J选择从颈外侧向内侧穿刺或从颈中线经甲状腺峡部向外侧穿刺 需对甲状腺包膜四周间隙尤其是前包膜与后包膜处进行局部麻醉 ＂液体隔离带＂法可保护颈总动脉和喉返神经免受刺伤与热损伤 对血供丰富的腺瘤先阻断其滋养动脉再穿刺切割活检可明显减少出血 多点多平面逐步消融可提高凝固的全面性和彻底性 超声造影示消融区无增强是终止消融的重要指征.结论 本研究所阐述的穿刺方法、技术要点与超声造影监测令甲状腺腺瘤射频消融安全、可行,效果可靠,创伤更加轻微.
Objective To establish a treatment proposal of thyroid adenoma by using percutaneous radiofrequency ablation（RFA） and investigate its techniques and skills, means and steps, and safety and efficacy. Methods Contrast-enhanced ultrasound-guided percutaneous RFA of thyroid adenomas were conducted on 202 patients by using an auto-controlled bi-polar electrode system. The indications of thyroid RFA,the optimal puncture route,the ways of anesthesia administration, protection of vital neck vessels and recurrent laryngeal nerve（RLN） and reduction of bleeding from core biopsy, indicators of ending ablation procedure following a complete ablation were investigated and analyzed. Resalts An adenoma smaller than 20 mm in maximal diameter was the optimal candidate for RFA. Either of two puncture routes could be selected upon the target lesion＇s location. Areas surrounding to the thyroid capsule needed adequate local anesthesia to kill pain. Liquid-isolating maneuver could effectively protect carotid artery and RLN from core needle cutting and electrode heating injury. Advanced block of supplying arteries with heating markedly reduced bleeding involved in the biopsy. Multipoint and multicenter ablation was essential to a complete coagulation. Filling-defect in the ablated adenoma on CEUS was the key sign to terminate ablation procedure. Conclusions Percutaneous bi-polar RFA was proved feasible, effective, safe and supermicroinvasive for treating thyroid adenoma under the way stated here of puncture and technical points and use of CEUS for monitoring.
出处
《中华超声影像学杂志》
CSCD
北大核心
2010年第10期861-865,共5页
Chinese Journal of Ultrasonography
基金
基金项目：第二军医大学附属长征医院“三重三优”学科和人才建设专项基金（2（）05-03-16）
关键词
超声检查
微气泡
甲状腺肿瘤
导管消融术
Ultrasonography Microbubbles Thyroid neoplasms Catheter ablation
