Advances in study on complications encountered in ultrasonography-guided thermal ablation of benign thyroid nodules
Received date: 2023-02-28
Online published: 2023-08-31
自2000年来，超声引导下的热消融术已被广泛应用于甲状腺良性结节的治疗中。甲状腺及其周围组织结构复杂，故甲状腺结节热消融治疗中相继报道各种并发症，如声音改变、血肿等，并引起了临床重视。甲状腺良性结节热消融术的术中并发症包括神经损伤、血管损伤、皮肤烧伤及周围组织烧伤等，而术后并发症主要包括结节破裂、液化性坏死及甲状腺功能异常等。在术中并发症中，喉返神经损伤是最常见的并发症，表现为声音改变，采用射频消融术及微波消融术治疗良性甲状腺结节时，其发生概率为0.4%~8.1%，其他神经损伤包括霍纳综合征、臂丛神经损伤；血管损伤表现为出血及血肿；周围组织烧伤包括皮肤烧伤、气管烧伤及食管烧伤。在术后并发症中，结节破裂多发生于术后1周~6个月；液化性坏死是BTN热消融术后少见的并发症；甲状腺功能异常，包括甲状腺功能减退及亢进。本文就甲状腺良性结节超声引导下热消融术中及术后并发症的发生表现及对策进行综述，为临床诊治提供参考。
华晴, 周建桥 . 甲状腺良性结节超声引导下热消融并发症研究进展[J]. 诊断学理论与实践, 2023 , 22(02) : 184 -189 . DOI: 10.16150/j.1671-2870.2023.02.013
Since 2000, ultrasonography-guided thermal ablation has been widely applied in treating benign thyroid nodule(BTN). However, considering complicated structures of thyroid gland and its surrounding tissues，various complications （such as voice change and hematoma）have been reported and attracted clinical attention. Intraoperative complications encountered in thermal ablation of BTN comprises of nerve (including the recurrent laryngeal nerve, sympathetic nerve and brachial plexus nerve) injury, vascular injury, skin burn and surrounding tissue burn, while postoperative complications mainly include nodule rupture, liquefactive necrosis and abnormal thyroid function. Among intraoperative complications, nerve injury is characterized by vocal changes, which is the most common complication. In the treatment of BTN using radiofrequency ablation and microwave ablation, occurrence rate of vocal changes is 0.4% to 8.1%. Other nerve complications include Horner's syndrome and brachial plexus injury. Vascular injury manifests as bleeding and hematoma; Burns to surrounding tissues include skin burns, tracheal burns, and esophageal burns. Postoperative complications include nodule rupture and abnormal thyroid function.Nodule rupture often occurs 1 week to 6 months after surgery. Liquefactive necrosis is a rare change after BTN using thermal ablation surgery. Abnormal thyroid function includes hypothyroidism and hyperthyroidism. This article reviews the manifestations of complications during and after ultrasound-guided thermal ablation of BTN, providing reference for diagnosis and treatment of complications.
Key words： Complication; Thermal ablation; Thyroid nodule; Ultrasound
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