| Objective:To explore the validity and security of radiofrequency ablation in treatment of thyroid papillary tiny carcinoma, By observing patients with thyroid papillary tiny cancer ablation focal size at different periods after radiofrequency ablation for change, neck lymph nodes and the situation of the thyroid parenchyma, this studyaims to provide theory basis for radio-frequency ablation technique in the treatment of thyroid papillary small carcinoma.Methods1,53 patients were treated by the radiofrequency ablation under guided by ultrasound.53 patients were biopsy diagnosis of thyroid papillary carcinoma before the radio frequency (RF).Before ablation, the US examination and laboratory studies were performed with all patients. The number of lesion, size, internal echo, morphology, boundary, calcification, blood flow signals, location and adjacent anatomy relationship were recorded.2, The patient was supine posture, he leaned back his head and exposed to his neck fully. The doctor chose the point positioning under guided by ultrasound, the doctor routine disinfection shop towels,1% lidocaine hydrochloride subcutaneous after the local anesthetic, Doctor with 18 PTC needle puncture to thyroid capsule local injections of 15 ml of 1% lidocaine hydrochloride, the doctor will be 18 g RF needle under guided by ultrasound in thyroid lesions in the deep place, the doctor set RF meter the output power, it is 3 w, the doctor start the therapeutic apparatus and ablation, the doctors by real-time ultrasound check to RF needle, strong echo boundary with the extension of treatment time gradually expanded, When the strong echo was no longer increasing range, it reveal local treatment ends, the doctor then removed to RF needle ablation area to continue treatment, When the strong echo surrounded the entire lesion and its surrounding, it showed that the RF ablation lesions over.4, The doctor observation time were Radio frequency (RF) before and the RF after 1,3,6,12 months. The doctor evaluation indicators include:1) the lesion size, volume, shape; 2) ultrasound imaging observation ablation area necrosis range; 3) whether there is a thyroid tumor recurrence; 4) if there is a neck lymph node metastasis.Results1, The conventional ultrasound before 1, radio frequency (RF):52 nodules were low echo and a nodule was mixed echo; 40 nodules aspect ratio were greater than or equal to 1 and 13 nodules aspect ratio were less than 1; 23 nodules boundaries were clear and 30 nodule boundary were not clear,34 nodule inside and around were no blood flow signals,18 nodules are dotted around the blood flow signals and a nodules was rich in blood flow; micro calcifications were in 21 nodes and no micro calcifications were in the 32 nodules and bulky calcifications.;2, Contrast-enhanced ultrasound inspection before the radio frequency:53 thyroid papillary tiny cancer nodules all have different degrees of enhancement, Start time was (7.5 ±1.1) s, Peak time was (10.6 ±3.1) s, fade time was (16.2±3.5) s; 4 nodules were even lower enhancement,3nodules were synchronous enhancement,1 nodule is peripheral ring high strengthening,45 nodules were low uneven enhancement.3, Two-dimensional ultrasound findings after radiofrequency ablation instantly: these focal ablations boundary were not clear and strong echo was uneven echo area in ultrasound after radiofrequency ablation immediately, Melt the largest diameter of the oven than increase before nodule biggest diameter, nodal maximum diameter average increase rate was 39.76%, the average volume increase rate was 24.97% (p< 0.05).4, Contrast-enhanced ultrasound examination after radiofrequency ablation instantly:melt filling defect ovens were anechoic area after 53 small nodules RF, it means that no contrast agent perfusion in the melt stove, it proved nodal ablation, melting range of the oven was greater than the nodule enhancement before ablation area; A complete ablation rate was 96.22% (51/53); Two small nodules on the edge of a little higher than its surrounding normal tissues was high echo genicity, it proved that there were residual tumor tissues of survival, the doctor in time to supplement radiofrequency ablation, nodules were anechoic area in the second procedure, it prompts tumor residual foci disappeared.5, follow-up results:in the follow-up process, blood perfusion of the ablation area disappeared in ultrasound examination after radiofrequency ablation treatment, it confirmed the volumes gradually narrow, Focal ablation after radiofrequency ablation 1 months,3 months,6 months and 12 months shrinkage rate were 21.51%,51.16%,84.29% and 51.16% respectively (P< 0.05 and preoperative); a patient with ablation area disappeared after treatment for 3 months,4 cases of patients with ablation area completely disappeared after 6 months,12 patients with focal ablation completely disappeared in 1 year after treatment; 52 patients achieved disease-free survival (cure rate 98.4%) after radiofrequency ablation for the first time,1 patient was found to be the primary focal local recurrence after radiofrequency ablation for six months, patients need to undertake secondary radiofrequency ablation,1 case was found to have a neck lymph node metastasis in patients with in 12 months after treatment (recurrence rate was 3.76%). thyroid function of patients with radiofrequency ablation therapy remain normal.6.Postoperative biopsy:53 patients with thyroid carcinoma were done the postoperative biopsy, Pathological results showed that:1 case of patients with primary focal organization was found to have a nuclear groove and intra nuclear,doctors considered papillary carcinoma recurrence; 52 cases patients with focal ablation have not been found within the residual tumor tissues.7. Complications:All patients were not found to have laryngeal recurrent nerve injury, skin airway burns and other severe complications occurred after treatment. In local anesthesia effect disappears,6 patients (11.5% incidence) had neck feeling mild pain; 1 patient (1.9%) of the puncture needle ablation parts was found to have a small amount of bleeding, patients oppressed after 30 minutes, there is no active bleeding.8 Papillary tiny cancer recurrence after radiofrequency:1 case of primary tumors was developed with local recurrence and 1 case was found with lymph node metastasis (total 3.76%).Conclusion1, Radiofrequency ablation is a minimally invasive, effective and safe treatment. Its treatment time is short and less complications and less light. Its controllability is strong, it has no scar, small trauma, good cosmetic effect, it's operation is convenient and simple. It can achieve the goal of minimally invasive.2, Ultrasonic imaging compared with conventional ultrasound, it not only can determine the residual lesions in operation, and give directions to guide supplement ablation. It can exactly reflect the melting range in radio frequency (RF) postoperative, it can evaluate liquefaction, necrosis, absorption rate of the lesions and tiny cancer relapse, it can better evaluate the efficacy of the radio frequency ablation.3,The prognosis of thyroid papillary carcinoma is good after radiofrequency ablation treatment, after radiofrequency ablation, disease-free survival rate was more than 95% in this study, Postoperative complications:there were 6 cases of the neck aches incidence (11.5%) and was a case of a small amount of bleeding incidence (1.9%) in this study; Relapse:there were 2cases (total recurrence rate 3.76%) in this study, radiofrequency ablation of thyroid papillary tiny cancer has certain effectiveness and safety, this study can provide theory basis for radio-frequency ablation technique in the treatment of thyroid papillary small carcinoma. |
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