I. Technical Introduction
The traditional treatment of thyroid nodules is surgical resection. Image-guided percutaneous radiofrequency ablation technology is a new method of tumor treatment carried out at home and abroad in recent years. The technology is to implant water-cooled ablation electrodes into the lesion under ultrasound guidance, causing coagulative necrosis of the lesion tissue through high temperature heating, and finally the necrotic tissue is absorbed by the body, so as to achieve the purpose of minimally invasive local inactivation of the lesion. Ultrasound-guided radiofrequency ablation is a safe and effective method for the treatment of thyroid nodules.
II. Indications
1. Benign thyroid nodules that meet the following conditions.
①Nodules larger than 2 cm in diameter or nodules found to be increasing in size during follow-up.
(2) Subjective symptoms, such as neck discomfort or pain, difficulty in breathing or swallowing, etc.
③Aesthetic needs.
④Psychological burden due to thyroid nodules.
⑤ Poor general condition that cannot tolerate surgery or refuses surgery.
2. Malignant tumors of the thyroid gland:
For patients with recurrent thyroid malignant tumors who have lost the opportunity to undergo surgery, radiotherapy and chemotherapy again, ablation can be used to destroy the lesions for the purpose of tumor elimination or reduction, thus improving the patient’s quality of life and prolonging survival. If the lymph nodes in the neck recur and metastasize after clearance surgery.
Contraindications
1.Blood mechanism disorder:
Those with severe bleeding tendency and severe cardiopulmonary disease that cannot tolerate treatment are still considered as contraindications.
2.Relative contraindications.
①Nodules less than 2cm.
②Puncture biopsy results of follicular or malignant tumors.
(3) Although the biopsy result is benign, the ultrasound sonogram is highly malignant (longer than wide diameter, significant hypoechogenicity, microcalcifications, unclear border, etc.)
Preoperative preparation
1. Imaging examination: ultrasound or ultrasonography, etc. In order to understand in detail the location, shape, size, blood supply inside and around the nodule and the relationship between the nodule and the surrounding structures, and to determine the best needle site and route.
2.Other tests: chest X-ray and electrocardiogram.
3.Blood tests: serum four, coagulation function, thyroid function, serum calcium, etc.
4.Puncture biopsy: Fine needle aspiration or coarse needle aspiration biopsy under ultrasound guidance is required to clarify the diagnosis before surgery.
5.Sign the informed consent for surgery: follow the principle of informed consent, explain the condition to the patient or family before treatment and introduce the significance of radiofrequency treatment and the possible complications during and after treatment and their countermeasures.
6.For those who have bleeding tendency, use vitamin K or Lizhixue before and after the operation.
IV. Complications and treatment
Radiofrequency ablation is a safe and effective method for treating thyroid tumors with low complication rate.
The common complications are
1. Burning sensation and pain in the neck: it is a common complication, sometimes radiating to the head, teeth, shoulders and chest.
2, fever: rare, mainly the body’s reaction to radiofrequency high temperature fever and the absorption of necrotic tissue fever, symptomatic treatment can subside.
3, extra-thyroidal hematoma: early incidence of about 2.1%, mostly disappears within 1 month.
4.Returning laryngeal nerve injury: a more serious complication, with a general incidence of about 1.3%.
5, thyroid function abnormalities: rare and mild, no need for medication, usually will be found in a week, the examination will return to normal after one month.
6, other complications: rare, such as infection, important structural damage (including the skin of the larynx, trachea, esophagus, blood vessels, etc.).