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目的观察Graves病栓塞后的甲状腺组织动态病理变化。方法15例甲状腺动脉150 mm聚乙烯醇(PVA)微粒及平阳霉素栓塞治疗的Graves病患者,于术前、术后7天、3个月、6个月、1年、3年分别行甲状腺穿刺活检,共行44次穿刺活检,其中动脉栓塞术前15例、栓塞术后7天2例、3个月3例、6个月6例、1年5例次、3年13例次。结果栓塞后7天主要表现为凝固性坏死;栓塞后3~6个月表现为纤维组织增生变性和淋巴细胞浸润,滤泡灶性坏死为主;栓塞后1~3年主要表现为间质纤维组织增生明显和滤泡萎缩,部分散在增生滤泡被纤维间质分隔包裹,难以形成腺小叶结构,滤泡周围血管网减少。结论经甲状腺动脉栓塞治疗Graves病,甲状腺组织的病理变化是在栓塞后近期内主要表现为急性缺血坏死,然后表现为持续的慢性炎性破坏、滤泡萎缩、部分滤泡增生被明显增生的纤维组织分隔包裹的变化过程。提示微循环栓塞能肯定地破坏甲状腺组织,达到治疗Graves病较好的疗效。
Objective To observe the dynamic pathological changes of thyroid tissue after Graves’ disease embolism. Methods Thirty-five patients with Graves’ disease treated with 150 mm PVA particles and pingyangmycin in thyroid artery underwent thyroid surgery at 7 days, 3 months, 6 months, 1 year and 3 years after operation. A total of 44 biopsies were performed, including 15 before arterial embolization, 2 at 7 days after embolization, 3 at 3 months, 6 at 6 months, 1 in 5 cases and 13 cases in 3 years. Results 7 days after embolization, the main manifestations were coagulation necrosis; 3 to 6 months after embolization showed fibrosis and lymphocytic infiltration, and follicular necrosis; 1 to 3 years after embolization, the main manifestations were interstitial fibrosis Significant proliferation of tissue and follicular atrophy, some scattered hyperplastic follicles were interspersed with interstitial fibrosis, glandular leaflet structure is difficult to form, reduce the vascular network around the follicle. Conclusion Thyroid artery embolization treatment of Graves disease, pathological changes of thyroid tissue in the short term after the embolization of the main performance of acute ischemic necrosis, and then showed persistent chronic inflammatory destruction, follicular atrophy, some follicular hyperplasia were significantly proliferated Changes in the separation of fibrous tissue packages. Tip microcirculation embolization can certainly destroy the thyroid tissue, to achieve a better therapeutic effect of Graves disease.