| Part 1 Clinical Analysis of Local Adhesions after Microwave Ablation of Thyroid NodulesObjective: To explore the probability and relative factors of local adhesion after radiotherapy of thyroid nodules.Research object: 217 patients accepted the thyroid nodules after microwave ablation at acupuncture treatment agency in Changzheng Hospital during Jan 2015 – July 2015.Methods: After 1 month when thyroid nodules after microwave ablation,determining whether the adhesion exist and calculating the overall incidence of adhesions according to its clinical performance.According to the number of ablation,217 patients were divided into the first complete ablation group and staging group,and the effect of ablation frequency on postoperative adhesions was analyzed.The number of ablation,nodule position,single / multiple nodule,nodule volume and ablation time were selected as the influencing factors of adhesion,and the logistic regression model was used to analyze the multivariate analysis.Results: 217 cases of thyroid nodules after microwave ablation were reviewed after 1 month,of which no adhesion in 160 cases,and 57 cases in adhesions,resulting the overall incidence of adhesion as 26.3%.According to the number of ablation of the patients,there were 182 cases of complete ablation in 217 patients,35 cases of phased ablation and 2 cases of local adhesions after 1 month.The results showed that postoperative adhesions(82.9%)were significantly higher than the first complete ablation group(15.4%),?2 = 69.00,P <0.005,presenting statistical difference.Logistic regression multivariate analysis: OR and P values of each parameter are number of ablation(OR = 13.030,P = 0.001),nodular position(OR = 3.264,P = 0.041),single / multiple nodules(OR = 1.276),and the odds ratio(OR = 13.030,P =(P = 0.573),nodule volume(OR = 1.118,P <0.001)and ablation time(OR = 1.010,P <0.001).The number of ablation,nodule position,nodule volume and ablation time were less than 0.05,there was statistical significance,and the effect was significant.However,multiple nodules(P> 0.05)were not statistically significant and had no significant effect on postoperative adhesions.The greater the number of ablation,the larger the nodule volume,and the longer the ablation time,the greater the likelihood of postoperative adhesions;the probability of adhesion after ablation of adjacent nodules was significantly higher than that of central nodules(OR = 3.264).Conclusion: Postoperative local adhesions,as one of the common complications after microwave ablation of thyroid nodules,have a higher incidence.Moreover,the nodular position and volume are important factors in the postoperative adhesion.Part 2 Effects of Different Concentrations of Sodium Hyaluronate on Prevention Adhesion of SD Rats after Microwave AblationObjectives: To explore the effect of different concentrations of sodium hyaluronate on local adhesion of SD rats after microwave ablation and its related mechanism;to find the optimal concentration of sodium hyaluronate to prevent adhesion after ablation.Methods: Eight healthy SD rats were randomly divided into four groups(each group with 20 rats): control group(group A),6 mg / ml sodium hyaluronate group(group B),10 mg / ml sodium hyaluronate group(group C),and 14 mg / ml sodium hyaluronate.The postoperative local adhesion model was established by microwave ablation of the dorsal muscle of the rats.After treatment with sodium hyaluronate in(excluding group A)B,C and D groups were treated with the corresponding concentrations of sodium hyaluronate.The S100A4 immunohistochemically observation and radiographs were performed on the posterior adhesions at 3d,1w,2w and 4w after operation.S100A4 immunohistochemically sections were analyzed by Image J software,and the fibroblasts were divided into four groups at different time points number,comparison and analysis.Results:1.Postoperative ablation grade after microwave ablationAt the third day after ablation,the adhesion of group A was longer than that of group B,C and D,but P was> 0.05,which was not statistically significant.The degree of adhesion was similar between group B,C and D,and the difference was not significant,which was not statistically significant.After 1 week,B,C,D three groups after ablation of the degree of adhesion was lighter than the A group,but only A group and B group presented a statistical difference(Pa.b = 0.035),while the other two groups,P value was greater than 0.05,meaning the difference was not significant.At 2 weeks,(Pa.b = 0.007,Pa.c = 0.040,Pa.d = 0.032),there was a significant difference between the two groups(P <0.05),and the degree of adhesion in group A was significantly higher than that in group B.The values of P were Pb.c = 0.042 and Pb.d = 0.038,respectively.There was significant difference between group B and group C(P <0.05),but there was no significant difference between group C and group D where Pc.d = 0.746,the difference between the two groups was not significant.At 4 weeks,the degree of adhesion was significantly improved compared with the previous group,the four groups were compared with each other,P> 0.05,presenting no statistical difference;but the naked eye observation,A group compared with the other three groups,there is still some adhesion exists,and Blunt is difficult to separate.2.Adhesive tissue fibroblasts countThe number of fibroblasts in group A was significantly higher than that in group B,C and D at 3 days after microwave ablation,and there was significant difference between group A and group B(P = 0.005).There was significant difference between group A and group C,while there was no significant difference between the two groups(Pa.c = 0.240,Pa.d = 0.158).The P values between group B and group C(P <0.05)were significantly higher than those in group C,D(Pb.c = 0.063,P = 0.102)and group C,D(Pc.d = 0.797).From the average histogram of the number of fibroblasts,it was found that the mean number of fibroblasts was the smallest.At 1 week,the number of fibroblasts in group B was significantly lower than that in group A,C and D,and all P <0.05(Pa.b = 0.000,Pb.c = 0.021,Pb.d = 0.009),meaning the difference was significant and statistically significant.There was no significant difference between group A and group C(P <0.05).There was no significant difference between group A and group C(P <0.05).The number of fibroblasts in group C was higher than 0.05 in P group,Pc.d = 0.682,so there was no significant difference between the two groups.At 2 weeks,the number of fibroblasts in group A was significantly higher than that in group B,C and D,and the number of fibroblasts in group B was significantly lower than that in group A,C and D.Additionally,group A with groups B,C,D three groups and B group and A,C,D between the three groups were less than 0.05,the statistical difference was significant.C group and D group,Pc.d = 0.135,no statistically significant.At 4 weeks,the P value was more than 0.05,that was,A,B,C and D,the difference between the two groups was not obvious.Conclusion:Sodium hyaluronate can reduce the occurrence of adhesion after microwave ablation,and different concentrations of sodium hyaluronate on its anti-adhesion effect of different effects.The experimental results in this study showed that the concentration of 6mg/ml sodium hyaluronate gel is best to prevent microwave ablation Postoperative adhesions.Moreover,the anti-adhesion effect of sodium hyaluronate is not only affected by its concentration,but also closely related to its dose,relative molecular weight and other factors.Part 3 Study on the Effect of Sodium Hyaluronate in Preventing Adhesion of SD Rats after Microwave AblationObjective: To determine the effectiveness of sodium hyaluronate in preventing local tissue adhesion of SD rats after microwave ablation.Methods: 120 rats were randomly divided into three groups(40 rats in each group): microwave ablation group(group A),microwave ablation and sodium hyaluronate group(group B),microwave ablation and sodium hyaluronate saline group(group C).The local adhesion model was established in muscle of rat back by microwave ablation,and sodium hyaluronate was applied in this model during operation.Biopsy was taken on the 3th,7th,14 th and 28 th postoperative day.The adhesion scores gradation judging,hematoxylin and Immunohistochemistry were observed and analyzed.Results: There were statistically significantly differences in the extent of adhesion between group B and group A,C on the 3th,7th and14 thpostoperative day(P<0.05),after ablation 4W,there was not statistically significantly differences among A,B,C three groups(P=0.458).Comparison between the two group,there was no statistical significance between the group A and C in the four time points(P> 0.05),however,on the 3th,7th and 14 th postoperative day,group B were significantly less than group A,C in the extent of adhesion,and there was statistical significance,P=0.029(3d),P=0.011(1w),P=0.004(2w).After ablation 4w,P=0.391,there was no statistical significance between group B and group A,C.Group A and C were more than group B in the aspect of hematoxylin and immunohisto chemical staining,the number of inflammatory cells infiltrated by lymphocytes,fibroblasts and macrophages,and the amount of collagen fiber deposition in A and C group were significantly harder than group B.Conclusion: Sodium hyaluronate appears to effectively reduce the local tissue adhesion after microwave ablation.Part 4.Initial Exploration of Sodium Hyaluronate in the Prevention of Local Adhesions after Microwave Ablation of Thyroid NodulesObjectives: To explore the method and application of sodium hyaluronate in microwave ablation of thyroid nodules,and to prevent the safety and efficacy of postoperative local adhesions.Methods: Sixty patients underwent microwave ablation of thyroid nodules were randomly divided into experimental group and control group.The rats in the experimental group were treated with sodium hyaluronate and the control group was not treated.The incidence of local adhesions and complications after ablation of patients were surveyed after 1 month.Results: The incidence of adhesion after microwave ablation was significantly lower in the experimental group than in the control group(P <0.05),presenting statistical difference.There were 3 cases of severe adhesions in the control group,and the degree of adhesions after microwave ablation was higher than that of the experimental group,and mild and severe adhesions were statistically significant.There were 2 cases of aseptic necrosis in the control group.One patient had no hoarseness after operation.No complication occurred in the experimental group.Conclusion: Sodium hyaluronate can safely and effectively reduce the local adhesion after microwave ablation of thyroid nodules;and can be used as a substitute for the current commonly used isolation fluid;and can play a new use,with most clinical application prospects. |
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