| Objective:To evaluate the efficacy and safety of thermal ablation in the treatment of thyroid papillary microcarcinoma by retrospective analysis of the follow-up of patients over 5years after thermal ablation in our center,so as to verify the feasibility and reliability of this technique under the condition of strict indications.Methods:181 patients with papillary thyroid microcarcinoma who underwent thermal ablation in our center from January 2013 to December 2015 were retrospectively analyzed.The preoperative ultrasound characteristics and thyroid function were summarized and analyzed.At 1 month,3 months,6 months and 12 months after operation,each patient was reexamined by color Doppler ultrasound.After 12 months,every patient was followed up once a year to observe the absorption of ablation area and local recurrence;thyroid function was reexamined at 1 month after operation.Results:1.Basic clinical data: The average age of the patients was 42.32±9.85 years(22-69 years),including 50 males and 131 females.The average follow-up time after operation was 66.38 ± 7.50 months(59-92 months).According to Bethesda classification,41 of them were in Grade 5 and 140 in Grade 6.Preoperative thyroid function examination showed that thyroid function was in the normal range,the average level of TSH was 2.85±1.60 m IU/L,the average levels of T3 and T4 were4.60±1.39pmol/L and 15.53±2.50pmol/L respectively.In addition,there were 7 patients with anti-TPO>100IU/L;most of the ablation nodules were located in the middle of the gland,nodules near the upper and lower poles take the second place;except 1 case with mixed echo nodules,the ablation nodules were mainly located in the middle of the gland The rest were hypoechoic nodules,most of which were non-calcified nodules(90.61%),and most of them had no obvious blood signal(64.64%);2.The evaluation of efficacy is mainly divided into three aspects,one is the local recurrence of ablation,the other is the regional absorption of ablation,and the third one is the metastasis.In 181 patients,there was no recurrence in situ,no new suspicious malignant lesions,and no suspicious lymph node metastasis;in the follow-up within 12 months after operation,the ablation area absorbed sharply at 1 month and 3 months after operation,and then the absorption gradually slowed down.Up to the latest followup of each patient,except for 31 patients who did not receive regular follow-up after operation,and one patient who died of colon cancer and lost follow-up,the ablation area could not be determined,and the ablation area of other patients had disappeared or only puncture needle path could be seen;3.The evaluation of safety mainly focused on the incidence of ablation related complications.There were no serious complications,such as bleeding and hematoma caused by neck vascular injury;hoarseness and dyspnea caused by recurrent laryngeal nerve injury;numbness and convulsion of hands and feet caused by parathyroid gland injury;tracheal injury and skin burn.All patients had different degrees of pain,most of them were tolerable,the operation could be stopped,no drugs were needed,and they all returned to normal within 1 week after operation;some patients had transient hoarseness,and their voice recovered within 2 hours after operation.After operation,4patients had thyroid dysfunction,1 patient had hypothyroidism and needed to take thyroxine;3 patients had hyperthyroidism(1 patient had a history of hyperthyroidism)and needed oral antithyroid drugs;4.The choice of different ablation methods: combined with the ultrasound characteristics of different target nodules and the general condition of patients,the nodules are larger and the blood supply is rich,so microwave ablation is preferred.After 37 months follow-up,there were still 7 × 7 × 7mm and 5 × 4 × 4 mm did not disappear completely.but disappeared in the last follow-up.Conclusion:1.On the premise of strictly grasping the indications,thermal ablation has high efficacy,low recurrence rate and metastasis rate,and has definite curative effect。It can be used as an alternative treatment for PTMC;2.The thermal ablation technique has high safety,no serious postoperative complications,thyroid function has not been significantly affected. |
