Clinical Study Of Ultrasound-Guided Microwave Ablation For Benign Thyroid Nodules

PART 1 Efficacy of microwave ablation in the treatment of benign thyroid nodulesObjective: To study the efficacy of microwave ablation in the treatment of benign thyroid nodules.Methods: A total of 246 BTNs treated by MWA were included from March 2018 to February 2022.All nodules were proved to be benign by pathology before operation,and Doppler ultrasound and thyroid function evaluation were performed before operation.The nodules were followed up regularly at 1 day,1 month,3 months,6 months and 12 months after operation.The changes of ablation focus volume,neck compression symptoms,cosmetic score and thyroid hormone level were observed.The nodule volume reduction rate was calculated,and the occurrence and outcome of complications were calculated.Results: After MWA,the volume of focus decreased gradually and VRR increased with time.The VRR at 1 month,3 months,6 months and 12 months after operation were(28.84 ± 31.39)%,(57.08 ± 28.09)%,(69.98 ± 28.76)% and(81.75 ± 19.12)%,respectively,and the treatment success rate(VRR > 50%)was 33.5%,71.9%,81.3% and 94.4%,respectively.In patients with cervical compression symptoms before operation,all the symptoms were relieved and disappeared gradually,and the cosmetic score was improved.The levels of T3,T4,FT3,FT4 and thyroglobulin increased temporarily after operation,and decreased temporarily after TSH.The above-mentioned indexes returned to the preoperative level 1 to 3 months after operation.6 patients developed hoarseness after operation,the incidence rate was 2.6%,all returned to normal within half a year;3 patients developed fever after operation,the incidence rate was 1.3%,and all recovered within a few days;4 patients had bleeding,the incidence rate was 1.7%,3 cases occurred during the operation,1 case appeared after operation,and the bleeding stopped after local pressing.No serious complications occurred.Conclusion: Ultrasound-guided MWA treatment of BTNs can significantly reduce nodules,effectively improve the symptoms of cervical compression,less complications,and has a good cosmetic effect.PART 2 Analysis of factors affecting the curative effect of microwave ablationObjective: To explore the factors affecting the curative effect of microwave ablation for benign thyroid nodules.Methods: 246 benign thyroid nodules treated by MWA from March 2018 to February 2022 were selected and the clinical data were complete.(1)Univariate analysis and multiple linear regression analysis were used to analyze the sex,age,presence or absence of Hashimoto’s thyroiditis,maximum diameter,volume,internal composition,blood flow grade,calcification and other factors of the patients and the volume reduction rate of ablation lesions one year after operation.(2)To make statistics on the risk factors that may lead to recurrent laryngeal nerve injury,chi-square test was used to analyze the relationship between recurrent laryngeal nerve injury and patients’ age,sex,Hashimoto’s thyroiditis,nodular volume,lateral type,location risk,internal composition,blood flow grade and intraoperative injection isolation zone width.To explore the related factors that may cause recurrent laryngeal nerve injury.Results:(1)Univariate analysis showed that the internal composition of nodules was the influencing factor of VRR one year after operation,while sex,age,Hashimoto’s thyroiditis,nodule volume,blood flow grade and calcification were not related to VRR one year after operation.Multiple linear regression analysis showed that the internal composition of nodules and blood flow grade were independent influencing factors of VRR 1 year after operation,while sex,age,Hashimoto’s thyroiditis,nodular volume and calcification were not related to VRR 1 year after operation.(2)Thyroid nodules in patients with recurrent laryngeal nerve injury were all located in high-risk areas.Chi-square test results showed that the risk of nodule location and the amount of intraoperative isolating fluid injection were related to recurrent laryngeal nerve injury.Sex,age,presence or absence of Hashimoto’s thyroiditis,nodule volume,lateral type,location risk,internal composition and blood flow grade were not related to recurrent laryngeal nerve injury.Conclusion: The internal composition of thyroid nodules and blood flow score were the independent influencing factors of VRR one year after operation,and the location of thyroid nodules and the width of isolation solution were the influencing factors of recurrent laryngeal nerve injury.