臺灣博碩士論文加值系統

本研究主要為評估經皮超音波導引良性甲狀腺結節射頻消融(Radiofrequency Ablation, RFA)術之成效。
採用回顧性實驗設計，收集2017年6月到2018年6月期間接受良性甲狀腺結節RFA共168例患者為良性甲狀腺結節，其中140例女性及28例男性；年齡範圍為13 -74歲、平均年齡44.9歲。運用單次經皮超音波RFA來治療的良性甲狀腺結節。所有良性結節都經過至少一次病理組織切片證實確認，手術前所有患者甲狀腺功能均為正常。對治療前及治療後1、3、6個月追蹤患者臨床症狀、外觀指數、甲狀腺結節體積及其前後變化。以描述性統計分析、卡方檢定、成對樣本T檢定以及廣益估計方程式分析法來評估治療的前後成效，其中包含甲狀腺功能、結節大小的前後變化以及症狀與外觀的改善。
平均完成每位病人RFA手術所需要的時間為15.0 ±9.2分鐘。所有患者和手術前的情況相比，在RFA後1、3、6個月追蹤時，病人的臨床症狀和外觀發生數都獲得顯著的改善 (p<0.001)。在接受RFA之前，病人甲狀腺結節的平均體積為35.55±64.89 mL， 計算公式為V = πabc/6；其中V是體積、a是最大直徑、b和c是另外兩個橫縱切垂直直徑。而在1、3、6個月的追蹤中，結節體積的平均減少率分別為43％、65％和77％。
經皮超音波RFA在治療良性甲狀腺結節上具有成效。此治療方式可以提供臨床應用及提升癒後率。

To evaluate the therapeutic efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) of benign thyroid nodules. From July 2017 to June 2018, we enrolled 168 patients (140 females, 28 male), aged 13–74y (mean age, 44.9 years) with benign thyroid nodules for a single session of ultrasound-guided percutaneous RFA. The benign nature of all the nodules was confirmed by at least one-time ultrasound-guided core biopsy, and all the patients had normal thyroid functions. The symptomatic score, cosmetic scores, and nodule volume of all the patients were recorded before treatment, and during 1, 3, and 6 months follow-up. Descriptive statistical analysis, chi-square test, paired sample T-test, and broad-spectrum estimation equation analysis were used to evaluate the effects of before and after treatment, including changes in thyroid function, nodule size, and improvement in symptoms and appearance.
The RFA procedures were completed with a mean time of 15.0 ±9.2 mins. The procedures were tolerated well in all the patients. Compared to the baseline conditions, significant symptomatic and cosmetic score improvement were found in 1 month, three months, and six months follow-up after RFA. Before RFA, the mean volume for thyroid nodules was 35.55±64.89 mL, and nodule volume was calculated using the equation V = πabc/6, where V is the volume, a is the maximum diameter, b and c are the other two perpendicular diameters. At the 1, 3 and 6-month follow-up, the nodule volume means reduction ratios were 43%, 65%, and 77%. Ultrasound-guided percutaneous RFA seems to be an effective and safe method for the treatment of benign thyroid nodules. It may gain wide use in clinical practice.

摘 要 I
Abstract II
誌謝 III
目錄 IV
表目錄 VI
圖目錄 VII
第一章 緒論 1
1-1前言 1
1-2研究動機與目的 4
第二章 文獻探討 5
2-1甲狀腺結節良惡性的診斷指標 5
2-2 使用RFA治療良性甲狀腺結節的成效 6
2-3 傳統療法與RFA比較 9
第三章 研究材料與方法 11
3-1 研究資料來源 11
3-2 消融設備及條件 12
3-3 研究方法與流程 13
3-4 術前的評估體積大小分組 14
3-5 術後1、3、6個月隨訪紀錄評估 15
3-5-1 體積估算 16
3-5-2 外觀及臨床症狀紀錄 16
3-6 統計分析 16
3-6-1 描述性統計 16
3-6-2 卡方檢定&無母數分析 16
3-6-3 成對樣本T檢定(Paired T-test) 16
3-6-4 廣益估計方程式分析法 17
3-7 成效評估 18
3-7-1 體積變化率 18
3-7-2 外觀及臨床症狀變化 18
第四章 結果 19
4-1統計分析 19
4-1-1 描述性統計 19
4-1-2 卡方檢定&無母數分析 21
4-1-3 成對樣本T檢定Paired T-test 23
4-1-4 廣益估計方程式分析法 24
4-2成效評估 27
4-2-1 體積變化率 27
4-2-2 外觀和臨床症狀變化 28
第五章 結論與討論 29
5-1 結論 29
5-2 討論 30
5-3未來研究方向 31
參考文獻 35
附錄一、甲狀腺疾病分級與建議 附-1
附錄二、微創治療方式之優缺點 附-2
附錄三、治療效果定義 附-3
附錄四、人體試驗臨床試驗同意證明書 附-4
附錄五、疼痛量表 附-5
附錄六、IRB授權書 附-6

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