| Chapter I The Clinical Study of Ultrasound-guided Microwave Ablation in the Treatment of Low-risk Papillary Thyroid MicrocarcinomaObjective:To investigate the safety,efficacy and clinical application of ultrasound-guided microwave ablation in the treatment of low-risk papillary thyroid microcarcinoma.Methods:From October 2010 to March 2018,119 patients with single focus thyroid papillary carcinoma were treated by ultrasound-guided microwave ablation in the Department of ultrasound medicine of our hospital.US and thyroid function evaluation were followed at 1,3,6 and 12 months after treatment and every 6-12 months thereafter.The complications,tumor absorption,thyroid hormone changes,recurrence and cervical lymph node metastasis were observed.Results:The follow-up duration after MWA was 37.2±20.9 months(range,12-101 months),20 cases were followed up for at least 5 years and 51 cases were at least 3 years.Tumour volume decreased significantly,from 1.87± 1.03 ml immediately after MWA to 0.01 ±0.04 ml at the final evaluation(p<0.001),with a mean volume reduction ratio of 99.4±2.2%.107 cases(93.9%)got complete remission at the final evaluation that presented as tumours disappeared or needle tracks/crevice echo.A patient(0.88%)was detected with cervical lymph node metastasis at the 26 months follow-up and underwent one additional MWA treatment successfully.No distant metastasis was observed.Seventeen patients mentioned in our previous study were followed up for more than 5 years and no cervical/distant metastasis was observed.All the acquired histological pathology results confirmed the absence of residual or recurrent tumuor cells after MWA.No delayed complications associated with MWA were encountered for all the patients during the longer-term follow-up period.Conclusion:Ultrasound-guided microwave ablation of low-risk papillary thyroid microcarcinoma can achieve the following effects:less trauma,faster postoperative recovery,no scar,good cosmetic effect,no need for lifelong medication,etc.It has a wide clinical application prospect and is expected to become an alternative surgical method for the treatment of papillary thyroid microcarcinoma.Chapter Ⅱ The Preliminary Study on Ultrasound-guided Microwave Ablation for T1bN0M0 Thyroid Papillary CarcinomaObjective:To investigate the clinical effect and safety of ultrasound-guided microwave ablation in the treatment of T1bN0M0 papillary thyroid carcinoma.Methods:12 patients of thyroid papillary carcinoma confirmed by biopsy were treated by ultrasound-guided microwave ablation.The maximum diameter of the tumor is 1.41 ±0.22 cm(1.18-2.00 cm)without lymph node metastasis and distant metastasis.Before operation,the size,location,boundary,adjacent relationship,calcification and blood flow of the nodules were fully evaluated,and the relevant examinations were improved.Follow-up at 1 month,3 months,6 months,12 months,18 months,and 24 months,observe tumor volume changes,complications,recurrence and lymph node metastasis,thyroid function,etc.Results:12 cases of papillary thyroid carcinoma were treated by microwave ablation under the guidance of ultrasound,and the effect was satisfactory.At 1,3,6,12,18 and 24 months after ablation,the reduction rate of ablation volume was-158.05± 88.18%,-47.27± 49.15%,45.48±20.88%,77.41±21.98%,90.66±9.92%,97.47±5.54%.At 12 months after ablation,2 cases disappeared,and 4 of 6 cases disappeared after 24 months follow-up.No severe complications occurred in all patients.One patient developed hoarseness and returned to normal within 1 month.During the follow-up,no tumor recurrence,lymph node metastasis or distant metastasis was found.Conclusion:Ultrasound-guided microwave ablation of T1bN0M0 thyroid papillary carcinoma is safe and feasible,which provides reliable evidence for clinical treatment. |
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