Interventional therapy for thyroid cancer

Treating diseases: thyroid cancer Indication Interventional therapy is indicated for the treatment of thyroid cancer. Contraindications 1. Various acute infections and local skin infections. 2. Severe liver and kidney dysfunction, severe arrhythmia and various bleeding disorders. Preoperative preparation 1. Do a good job of pre-operative examinations. 2. Prepare the equipment. 3. Introduce the treatment method and purpose to the patient to obtain patient cooperation. Surgical procedure 1, intubation method Methods of interventional therapy include intubation arterial chemotherapy and/or embolization and chemical or physical ablation. Seldinger technique was used for intubation, and the catheter was inserted into bilateral STA and ITA DSA angiography to understand the blood supply of thyroid and thyroid cancer. If the lesion is more limited, the microcatheter can be further inserted into the branch of the above artery, and then subjected to chemotherapy perfusion or chemoembolization. Located in the thyroid isthmus or larger thyroid cancer, often multiple arteries supply blood, so sometimes bilateral STA and ITA angiography is required. A small number of thyroid cancers close to the lower pole must also have the lowest thyroid artery angiography. 2, drugs and embolic agents Drugs commonly used for intra-arterial infusion chemotherapy of thyroid cancer can be divided into two categories: concentration-dependent and time-dependent. The former such as mitomycin, doxorubicin, bleomycin, platinum compounds, etc., can be injected in large doses in a short time; the latter, such as fluorouracil, MTX, etc., maintain a long-term perfusion at a certain effective concentration, Ensure that the drug has enough time to kill the tumor cells. Recently, the author also tried paclitaxel and gemcitabine at the same time as arterial infusion and systemic intravenous drip, and received good results. The embolic agent can be selected from lipiodol and PVA microparticles. complication 1. Mis-suppression Because the tip of the tube is inserted into the target vessel, or the rate of injection is too fast, the perfused drug or embolic material may be reversed. STA regurgitation can endanger the external carotid artery, common carotid artery and internal carotid artery; ITA reflux can endanger the upper extremity artery, common carotid artery and vertebral artery. The reflux of the internal carotid artery and the vertebral artery can cause cerebral vasospasm, cerebral infarction, and even death. Therefore, the depth of the tip of the tube into the target vessel should not be less than 3 mm, and the injection should be performed under X-ray TV monitoring. 2. Chemotherapy perfusion and/or embolization of thyroid-associated arteries may lead to rupture of thyroid gland, thyroxine entering the blood circulation causing transient hyperthyroidism and even crisis, and should be treated accordingly, and can be relieved within 2 to 4 days. 3. Interventional treatment of thyroid-related arteries can lead to adjacent small blood vessels in the throat and neck, or ischemia. Patients will feel pain and fever in the throat and neck during and after surgery. After embolization of thyroid cancer, local edema compresses the trachea or throat, and the patient feels difficulty breathing. The above symptoms can be treated symptomatically, and disappear within 3 to 5 days. If necessary, the tracheotomy is performed to keep the breathing open.

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