| Purpose: Ultrasound-guided percutaneous microwave ablation of thyroid benign nodules has been widely used in clinical,but the treatment of thyroid papillary carcinoma is still controversial.The aim of our study was to summarize the safety,feasibility and efficacy of ultrasound-guided percutaneous microwave ablation of single thyroid papillary carcinoma.Method: From June 2013 to December 2013,26 patients with single thyroid papillary carcinoma(PTC)who had been diagnosed by fine needle aspiration cytology or core needle biopay underwent ultrasound-guided percutaneous microwave ablation,including 18 women,male 8 example.In addition to 2 patients with a maximum diameter of 1.0cm(the largest diameter of 2.5cm,1.2cm),the remaining diameter of less than 1.0cm.All patients were pre-medicated with 1U intramuscular haemocoagulase injected to reduce bleeding during the procedure.After localisation of the best puncture site,local anesthesia with 1% lidocaine was administered.Then we carefully injected a mixture of 0.9% lidocaine and physiological saline solution into the surrounding thyroid capsule to achieve a‘liquid isolating region' to protect the majorstructures.A MW needle was percutaneously inserted into the nodule and positioned in its designated place under ultrasound guidance with output power of 35 W.The therapy was not stopped until the hyperecho covered the whole tumour.The main method is fixed every level fixed electrode technique.Each level ablation is generally 40 s.Ultrasound contrast examination must be done to assess the scope of the lesion ablation area 2-3 days after ablation.The time of follow-up was 2-3 days after ablation,1,3,6,9,12,18,24,30,and 36 months respectively.The volume change,disappearance time,adverse reaction and complication were observed after thyroid nodule ablation.Except that Whether the new lesions and lymph node metastasis occurred or not should be observed.After 7-10 days of ablation,all patients underwent hormone suppression therapy to maintain thyroid hormone(TSH)levels below 0.1 mU / L.Result: All patients were treated with one-time ablation and no transferring operation.All patients were followed up for 36 months.The results of ultrasonography showed that the ablation area completely covered the lesion and expanded significantly.The ablation area could not be seen contrast micro bubble entering.According to the degree of noduleabsorption,PTC microwave ablation prognosis can be divided into two categories:(1)complete absorption type: 19 cases(73%)completely absorbed,the fastest absorption(1 case)occurred in the first 3 months,13 cases in 12 months.(2)Fissure type: 7 cases(27%)showed a fissure-like structure after 9 months or 12 months follow up,and the fissure-like structure was remained to 36 months.All patients did not occurred thyroid hemorrhage,neck hematoma,esophagus,tracheal injury,skin burns and infections and other complications.Furthermore All patients had no suspicious recurrence by either clinical and ultrasound examination or distant metastases by chest and upper abdomen CT scans.Although most patients reported a burning sensation,pain,or both,no one asked to stop,and the symptoms were relieved without treatment within 12 h.Two patients developed a change in sound at the end of ablation: one patient recovered 1 hour after ablation.Another recovered about 1.5months later.1 case was founded hypoechoic lymph nodes in the cervical VI area after 1month follow up,and disappeared in 3 months follow up.1 case was founded abnormal lymph nodes in the 6 months follow up in the IV area of the neck.The result of needle core biopsy is reactive hyperplasia lymph node.8 patients' s thyroid volume reduced after ablation,and 2 patients had hashimoto's thyroiditis.Conclusion: Ultrasound-guided percutaneous microwave ablation can also be used in treating solitary papillary thyroid.The results from this group of cases showed that ultrasound-guided percutaneous microwave ablation of solitary thyroid papillary carcinoma is a safe,feasible and effective treatment.All patients were treated with levothyroxine after MW ablation to maintain TSH levels below 0.1 mU/L. |
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