Clinical Study Of The Thermal Ablation Of Thyroid Nodules Under Ultrasound Guidance

Objective : To discuss the clinical results and treatment experiment of ultrasound-guided percutaneous thermal ablation of benign thyroid nodules.Method: All 93 cases of ultrasound-guided percutaneous thermal ablation of benign thyroid nodules were acquired from thyroid surgery department of the China-Japan Union Hospital of Jilin University from January 2013 to December 2014. Their clinical information were retrospectively analyzed. The cervical ultrasound of all 93 cases showed that nodules were solid or mixed of cystic and solid, with clear boundaries and no apparent calcification, and that there were no abnormal neck lymph nodes. All patients underwent preoperative fine needle aspiration biopsy, and the results in return showed follicular epithelial cells and glial cells without cancer cells. 93 cases included 27 cases of radiofrequency ablation and 66 cases of microwave ablation. Patients regularly followed up for 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months after thermal ablation.Results: All 93 cases of thermal ablation were successfully at the first. After surgery, ablation zone were without blood flow, and contrast enhanced ultrasound showed filling defect at ablation zone. One patient were found abnormal blood flow under the ultrasound, and treated with intraoperative microwave successfully, while for other patients serious complications did not occur at all intraoperatively and postoperatively. During follow-up, 25 patients were lost in a temporary state, accounting 26.88% of the total number of cases(25/93), and the loss ratio respectively was 20.59%(7/34) and 30.51%(18/59) of the cases undergoing thermal ablation in 2013 and 2014(P>0.05). During follow-up, ablation zone of all patients had no significant blood flow signal, and ablation region gradually reduced, without abnormal neck lymph nodes. The nodule reduction rate and nodule disappearance rate of all patients was 92.55% and 72.16%.The nodule reduction rate of 2014 and 2013 gradually increased, and respectively was 88.52% and 94.54%.The nodule disappearance rate also gradually increased, and respectively was 53.13% and 81.5%(P<0.05). The nodule reduction rate of radio frequency and microwave ablation respectively was 97.80% and 90.09%,while the nodule disappearance rate respectively was 87.10% and 65.15%(P<0.05). Thyroid function did not change significantly.Conclusion: Ultrasound-guided percutaneous thermal ablation treatment is a humanized and individualized treatment attempt. Ultrasound-guided percutaneous thermal ablation technology has many obvious advantages such as safe, reliable, and less complication. And well preoperative risk assessment, an experienced operator in conjunction with the use of "liquid buffer zone" and " the method to pry off leverage " can reduce the occurrence of complications. Thermal ablation techniques has no significant effect on patients preoperatively with normal thyroid function and can treat thyroid nodules with high selectivity while effectively retaining the thyroid function. Ultrasound-guided percutaneous thermal ablation technique in the treatment of benign thyroid nodules, is well effective and minimally invasive, and worthy of promotion, but its long-term efficacy also needs further follow-up observation.