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目的 探讨难治性Graves病介入栓塞治疗的临床疗效、安全性及栓塞后甲状腺病理形态变化。方法 2 2例难治性Graves病 ,经超选择插管至甲状腺上、下动脉 ,使用聚乙烯醇或白芨微球栓塞治疗 ,观察栓塞后临床症状及甲状腺大小的变化。对其中 6例伴巨大甲状腺者 ,栓塞后行手术治疗并观察栓塞后甲状腺病理形态变化。结果 6例栓塞 2～ 3周后行双侧甲状腺次全切除 ,手术顺利 ,临床治愈。未手术的 16例 ,除 2例尚需分别用他巴唑 5～ 10mg/d或丙基硫氧嘧啶 5 0～ 10 0mg/d治疗外 ,14例均获治愈。随访 3～ 30个月 ,甲状腺功能正常 ,甲状腺明显缩小 ,无严重并发症。甲状腺病理切片示甲状腺上、下动脉及其微细分支大部分闭塞、机化 ,相应甲状腺组织发生化学性炎症性坏死及纤维化。结论 介入栓塞甲状腺上、下动脉 ,可使Graves病临床治愈 ,为Graves病的治疗或作术前准备提供了一种有效的新方法。
Objective To investigate the clinical efficacy, safety and histopathological changes of thyroid after embolization in refractory Graves disease. Methods Twenty-two cases of refractory Graves’ disease were treated with superselective intubation of the upper and lower thyroid arteries and embolization with polyvinyl alcohol or Baiji microspheres. The clinical symptoms and thyroid size were observed after embolization. In 6 of them with giant thyroid gland, the patients underwent surgical treatment after embolization and observed the pathological changes of thyroid after embolization. Results Six cases underwent subtotal thyroidectomy 2 to 3 weeks after embolization, and the operation was successful and cured clinically. Sixteen patients without surgery were cured except two patients who needed to be treated with methimazole 5 ~ 10 mg / d or propylthiouracil 50 ~ 100 mg / d respectively. Follow-up 3 to 30 months, normal thyroid function, thyroid significantly reduced, no serious complications. Thyroid pathology showed thyroid upper and lower arteries and most of its fine branches occlusion, machine, the corresponding thyroid tissue with chemical inflammatory necrosis and fibrosis. Conclusion Interventional embolization of the superior and inferior thyroid arteries can clinically cure Graves disease and provide an effective new method for the treatment of Graves’ disease or preoperative preparation.