改良隔离液在甲状腺良性结节微波消融术中应用的安全性及有效性观察

doi:10.16139/j.1007-9610.2025.04.09

摘要/Abstract

摘要：

目的：生理盐水作为隔离带和玻璃酸钠-生物多糖混合液作为改良隔离带在甲状腺良性结节微波消融术（MWA）中应用的安全性及有效性的研究。方法：选取2018年8月至2022年2月在上海瑞金康复医院收治的甲状腺良性结节（最大直径≥20 mm）196例病人245个良性结节，采用生理盐水作为隔离液的MWA为对照组（n=114），采用玻璃酸钠-生物多糖混合液作为隔离液的MWA为改良组（n=131）。注入隔离液形成宽度约10 mm的隔离带，行MWA消融术。术中观察隔离液吸收时间，以术后12个月为随访终点，记录并发症，并评估结节体积大小变化（体积缩小率）。结果：改良组并发症发生率显著低于对照组（1.9%比14.0%，P<0.05），其中对照组92.3%的并发症与热损伤相关，而改良组则未观察到任何热损伤相关并发症。且改良组隔离液吸收时间明显延长[（15.2±1.6） min比（11.0±2.3） min，P<0.05]。两组结节体积缩小的总有效率差异无统计学意义（95.4%比96.5%，P>0.05）。结论：玻璃酸钠-生物多糖混合液在MWA术中作为隔离液具有保持时间长、隔热效果好的特点，且能降低粘连风险，减少失声、吞咽困难、烫伤等并发症的发生，具有较高的安全性，有利于术后康复。MWA对于甲状腺良性结节具有良好的治疗效果。

关键词: 甲状腺良性结节, 微波消融, 改良隔离液, 并发症, 玻璃酸钠-生物多糖混合液

Abstract:

Objective To investigate the safety and effectiveness of normal saline as a hydrodissection band versus sodium hyaluronate and biopolysaccharide mixture as a modified hydrodissection band in microwave ablation (MWA) for benign thyroid nodules. Methods A total of 196 patients with 245 benign thyroid nodules(maximum diameter ≥20 mm) treated at Shanghai Ruijin Rehabilitation Hospital from August 2018 to February 2022 were enrolled. Patients were divided into control group (n=114): MWA using normal saline as the hydrodissection fluid; modified group (n=131): MWA using sodium hyaluronate and biopolysaccharide mixture as the hydrodissection fluid. A hydrodissection band (about 10 mm wide) was established before MWA. Intraoperative hydrodissection fluid absorption time was recorded. At the 12-month follow-up endpoint, complications were assessed, and changes in nodule volume (volume reduction rate, VRR) were evaluated. Results The complication rate was significantly lower in the modified group (1.9% vs.14.0%, P<0.05). 92.3% of complications in the control group were thermal injury-related, while no thermal injuries occurred in the modified group. Hydrodissection fluid absorption time was significantly prolonged in the modified group [(15.2±1.6) min vs. (11.0±2.3) min, P<0.05].No significant difference was observed in overall treatment efficacy (nodule VVR) between two groups (95.4% vs. 96.5%, P>0.05). Conclusions The sodium hyaluronate and biopolysaccharide mixture demonstrates prolonged retention time and superior thermal insulation as an hydrodissection fluid in MWA. It reduces adhesion risks and complications such as hoarseness, dysphagia, and thermal injury, thereby enhancing procedural safety and postoperative recovery. MWA is an effective treatment for benign thyroid nodules.

Key words: Benign thyroid nodule, Microwave ablation(MWA), Modified hydrodissection fluid, Complication, Sodium hyaluronate and biopolysaccharide mixture

中图分类号:

R653

黄莉, 赵艳娜, 顾建华, 徐文娟, 柳俊, 费健. 改良隔离液在甲状腺良性结节微波消融术中应用的安全性及有效性观察[J]. 外科理论与实践, 2025, 30(04): 345-350.

HUANG Li, ZHAO Yanna, GU Jianhua, XU Wenjuan, LIU Jun, FEI Jian. Observation on safety and effectiveness of modified hydrodissection fluid in microwave ablation of benign thyroid nodules[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 345-350.

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Item	Modified group （n=103）	Control group (n=93)	t value	P value
Age(year)	46.3±13.9	49.0±15.0	0.953	0.200
Male∶Female	26（25.2）∶77（74.8）	18（19.4）∶75（80.6）	/	0.392
Nodule preoperative volume（mL）	20.3±10.4	20.0±11.5	1.069	0.240

Complications	Modified group（n=103）	Control group（n=93）	χ² value	P value
Neck discomfort, dysphagia	0	0
Hoarseness, loss of voice	0	9（9.7）
Horner syndrome	0	1（1.1）
Scald	0	2（2.2）
Nodular rupture	2（2.2）	1（1.1）
Total incidence	2（1.9）	13（14.0）	10.022	0.002

Item	Modified group	Control group	t value	P value
Number of nodules	131	114
Absorption time (min)	15.2±1.6	11.0±2.3	17.992	0.000

VRR	Modified group （n=131）	Control group (n=114)	χ² value	P value
<50％	6（4.6）	4（4.5）
50％~90％	38（29.0）	32（28.1）
>90％	87（66.4）	78（68.4）
≥50%	125（95.4）	110（96.5）	0.179	0.672