关键词: 结核, 超声检查, 介入性, 治疗应用

Abstract:

Objective: This study aims to evaluate the clinical efficacy and potential applications of ultrasound-guided microwave ablation as an adjunct to conventional anti-tuberculosis pharmacotherapy in the management of localized tuberculous lesions. Methods: A retrospective analysis was conducted on 12 patients with localized tuberculous lesions who underwent ultrasound-guided microwave ablation at the Shandong Public Health Clinical Center and the Shandong First Medical University Affiliated Provincial Hospital between March 2020 and January 2023. The cohort included 6 cases of lymph node tuberculosis, 4 cases of chest wall tuberculosis, and 2 cases of liver tuberculosis. Contrast-enhanced ultrasound (CEUS) was performed post-ablation for all patients to evaluate treatment efficacy. Follow-up assessments were carried out at 3, 6, 9, 12, and 24 months post-ablation to measure the ablation lesion volume and calculate its reduction rate. Data were expressed as median (interquartile range, M(P₂₅, P₇₅)) and analyzed using the Z-test to assess the effectiveness of the ablation procedure. Results: Contrast-enhanced ultrasound confirmed complete ablation in all 15 localized tuberculous lesions across 12 patients immediately after the procedure. During follow-up at 3, 6, 9, 12, and 24 months post-ablation, the median lesion volumes were recorded as 2.82 (1.62,5.85) cm³, 1.95 (1.54,4.59) cm³, 1.62 (0.15,4.02)cm³, 1.52 (0.00,3.98)cm³, 0.00 (0.00,1.64)cm³, respectively. Correspondingly, the shrinkage rates of the ablation lesions were 51 (36,59)%, 62 (52,72)%, 69 (58,97)%, 71 (62,100)%, 100 (72,100)%. By the end of the follow-up period, 8 ablation lesions had completely resolved. The reduction rate of ablation lesions at 24 months post-surgery was significantly higher compared to those at 3, 6, 9, and 12 months, with corresponding χ² values of -3.41, -3.18, -3.06, and -2.52 (P=0.001, 0.001, 0.002, and 0.012, respectively). No complications, such as peripheral organ damage, needle track implantation, or tuberculosis dissemination, were observed during or after the procedure. Furthermore, no active disease progression or recurrence was detected throughout the follow-up period. Conclusion: Ultrasound-guided microwave ablation demonstrates significant efficacy and safety in the treatment of localized tuberculous lesions, highlighting its potential as a valuable minimally invasive therapeutic option deserving broader clinical application.

Key words: Tuberculosis, Ultrasonography, interventional, Therapeutic uses