Microwave Ablation Of Mixed Thyroid Nodules And Management Of Intraoperative Intracystic Hemorrhage

Objective:Intracystic hemorrhage is not uncommon during ultrasound-guided percutaneous microwave ablation(MWA)for mixed thyroid nodules.The result could be the hematoma formation,extending of the surgery,the impact of postoperative nodules absorption,the expiratory dyspnea,or even a threat to life.The purpose of this research is to analyze influencing factors of intracystic hemorrhage in mixed thyroid nodules and to develop solutions.According to different types of mixed nodules this research sets individualized operation scheme respectivelyMethods:A total of 157 patients with mixed thyroid nodules who underwent ultrasound-guided percutaneous microwave ablation at the Ultrasound Intervention Center of the Second Affiliated Hospital of Dalian Medical University between May 30,2017 and October 30,2020 were selected,including 35 males and 122 females,aged20-83 years(average age 50±13 years).According to the presence or absence of intracystic hemorrhage of nodules during the operation,they were divided into a bleeding group and a non-bleeding group.The length,volume,cystic proportion,cystic fluid properties,and color Doppler of the two groups of mixed thyroid cyst-solid nodules were compared.Blood flow imaging(Color Doppler Flow Imaging,CDFI),enhanced mode(Contrast-enhanced Ultrasound,CEUS),operation time,operation method,and history of basic diseases.The two groups of data were analyzed with single-factor and multi-factor logistics regression models,and nomogram was drew,with basing on the important influencing factors,which can predict the risk of intraoperative nodules complicated by intracystic hemorrhage.Results:There were 25 cases of intracystic hemorrhage during ablation of mixed thyroid nodules,and the total incidence was 16%(25/157).The length of the nodule in the bleeding group ranged from 2.7-6.0cm,with an average of 3.70±0.95 cm,which was larger than the nodule length of the non-bleeding group by 2.0-5.7cm,with an average of 3.13±0.75 cm.There was a statistically significant difference between the two groups Significance(P=0.001).Nodule volume in the bleeding group ranged from 5.5-59.3ml,with an average of 16.9±0.98ml;nodule volume in the non-bleeding group ranged from1.2-46.1ml,with an average of 9.02±0.69 ml.There was a statistically significant difference in the volume of nodules between the two groups(P=0.000).There were statistically significant differences in CEUS and cystic fluid ratio between the bleeding group and the non-bleeding group(P = 0.051,P = 0.003).In the bleeding group,the contrast-enhanced ultrasound showed 19 cases of equal-enhanced nodules(19/25,76%).Spearman correlation coefficient r =0.258,P<0.05.There was a positive correlation between the nodule contrast-enhanced mode and the incidence of intrasaccular hemorrhage.In the bleeding group,there were 10 nodules(10/25,40%)with cystic components 50-70%,13 nodules(13/25,52%)with cystic components more than 70%,nodules cystic The more cystic components in the nodule,the higher risk of intraoperative bleeding.The operation time of the bleeding group was 40-125 min,with an average of 68.0±24.2min,which was higher than that of the non-bleeding group by25-115 min,with an average of 52.6±17.4min,and the difference was statistically significant(P=0.000).Based on the results of multivariate logistics regression analysis,3 independent variables(including the length of the nodule,contrast-enhanced ultrasound,and the proportion of cystic fluid)were used to predict the risk factors of intracystic hemorrhage during the operation of mixed thyroid nodules.The model prediction is consistent The index(C-index)is 0.823.The accuracy of predicting intraoperative intra-capsular hemorrhage of nodules is as high as 80.76%Conclusion:Ultrasound-guided percutaneous microwave ablation of mixed thyroid nodules can achieve the same effect as traditional surgery in alleviating the symptoms of patients.However,cases of intraoperative intracystic hemorrhage are not uncommon in clinical work.The performer should pay more attention to it.The nomogram predicts the risk of intraoperative nodular intrasaccular hemorrhage,timely prevention and correct management,and the development of a personalized surgical plan is of great value to clinical work.