Wang Yunjun, Sun Peixuan, Chang Cai, Tong Yuyang
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University.
Diagnostic Imaging Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University.
J Vis Exp. 2025 Aug 12(222). doi: 10.3791/68640.
The management of benign thyroid nodules has evolved significantly with the advent of minimally invasive techniques, offering patients effective alternatives to traditional surgery. Among these, radiofrequency ablation (RFA) and microwave ablation (MWA) have emerged as the leading modalities. RFA, the most widely adopted method, uses high frequency alternating current to induce thermal coagulation. MWA, though less established in thyroid applications, employs electromagnetic waves to generate rapid and intense heat, making it particularly effective for larger or hypervascular nodules. These approaches are particularly advantageous for patients with symptomatic nodules or cosmetic concerns, as they preserve thyroid function while minimizing complications and recovery time. This protocol establishes a standardized approach for RFA and MWA of benign thyroid nodules. The procedure begins with cytological confirmation (Bethesda II) and ultrasound evaluation, followed by local anesthesia and protective hydrodissection with 40-80 mL of 5% dextrose or distilled water to safeguard critical structures. Under real-time ultrasound guidance, the trans-isthmic approach is employed for needle placement. Ablation is performed at 30-40 W (RFA) or 35-50 W (MWA) using the moving-shot technique. Complete nodule devascularization is confirmed by contrast-enhanced ultrasound (CEUS) during post-ablation assessment, with immediate supplementary ablation being performed if residual enhancement is identified. Clinical and sonographic follow-up is conducted at 1, 3, 6, and 12 months to assess volume reduction ratio, symptom relief, and cosmetic outcomes. The protocol also details the patient selection criteria, technical nuances for cystic/solid nodules, and management of intraoperative complications. This comprehensive guide aims to optimize the reproducibility, safety, and efficacy of thermal ablation for benign thyroid nodules, serving as a practical reference for clinicians adopting these minimally invasive techniques.
随着微创技术的出现，良性甲状腺结节的管理方式发生了显著演变，为患者提供了传统手术的有效替代方案。其中，射频消融（RFA）和微波消融（MWA）已成为主要方式。RFA是应用最广泛的方法，利用高频交流电诱导热凝固。MWA虽然在甲状腺应用中不太成熟，但采用电磁波产生快速而强烈的热量，使其对较大或高血运结节特别有效。这些方法对有症状结节或有美容需求的患者特别有利，因为它们在保留甲状腺功能的同时，将并发症和恢复时间降至最低。本方案建立了良性甲状腺结节RFA和MWA的标准化方法。该程序首先进行细胞学确认（贝塞斯达II级）和超声评估，然后进行局部麻醉并用40 - 80 mL 5%葡萄糖或蒸馏水进行保护性水分离以保护关键结构。在实时超声引导下，采用经峡部入路进行针的放置。使用移动射击技术以30 - 40 W（RFA）或35 - 50 W（MWA）进行消融。消融后评估期间通过对比增强超声（CEUS）确认结节完全去血管化，如果发现有残余增强则立即进行补充消融。在1、3、6和12个月进行临床和超声随访，以评估体积缩小率、症状缓解情况和美容效果。该方案还详细说明了患者选择标准、囊性/实性结节的技术细节以及术中并发症的处理。本综合指南旨在优化良性甲状腺结节热消融的可重复性、安全性和有效性，为采用这些微创技术的临床医生提供实用参考。
