微波消融治疗不同初始体积甲状腺实性结节的疗效研究

doi:10.6040/j.issn.1673-3770.0.2021.336

摘要/Abstract

摘要： 目的探讨微波消融治疗不同初始体积甲状腺实性结节的有效性及安全性。方法回顾性分析超声引导下微波消融治疗的68例患者82个甲状腺良性结节,消融术后第1、3、6、12个月随访复查,计算体积缩小率(VRR)及并发症情况。将结节按照初始体积分为>12 cm³、9~12 cm³、4~8 cm³及<4 cm³四组,比较四组结节消融治疗有效性及安全性。结果甲状腺实性结节微波消融术后体积较术前呈进行性缩小,术后1、3、6、12个月VRR分别为(37.93±19.48)%、(61.69±14.76)%、(74.27±12.93)%、(84.92±10.35)%,差异有统计学意义(P<0.05)。体积>12 cm³组结节与9~12 cm³、4~8 cm³及<4 cm³组比较,消融时间长、消融能量大,术中疼痛评分高,差异有统计学意义(P<0.05)。术后1个月体积>12 cm³组与<4 cm³组结节VRR低于其他两组,差异无统计学意义(P>0.05)。术后3、6、12个月体积>12 cm³结节VRR最低,差异有统计学意义(P<0.05)。术后结节复发率14.6%(12/82),1例患者一过性声音嘶哑,无饮水呛咳等严重神经损伤并发症。结论微波消融治疗甲状腺实性结节安全有效,结节初始体积对疗效有一定影响,相对体积较小结节疗效更显著。

关键词: 微波消融, 甲状腺结节, 实性

Abstract: Objective This research aimed to investigate the effects of ultrasound-guided microwave ablation(MWA)on benign solid thyroid nodules with different initial volumes. Methods Eighty-two benign solid nodules that had received MWA were divided into four groups according to the initial volume(>12, 9-12, 4-8, and <4 cm³). The ablation parameter and volume reduction rate(VRR)for the four groups were calculated, and the recurrence rate and complication rate were recorded. Results The volume of nodules gradually reduced after 1, 3, 6, and 12 months; the VRR was 37.93±19.48%, 61.69±14.76%, 74.27±12.93%, and 84.92±10.35%, respectively(P<0.05). Compared with those of other groups, for the initial volume ≥ 12 cm³ group, the ablation time was longer and ablation power was higher(P<0.05); the pain score was higher(P<0.05); and the VRR was significantly lower at 3, 6, and 12 months(P<0.05). The recurrence rate was 14.6%(12/82). One case of transient hoarseness was recorded in the largest volume group. Conclusion Microwave ablation is a safe and effective treatment for benign solid thyroid nodules, and the curative effect of relatively small nodules is more significant.

Key words: Microwave ablation, Thyroid nodules, Solid

中图分类号:

R736.1

李思瑶,包宇涵,李昕莹,孙晓菁,曹小丽. 微波消融治疗不同初始体积甲状腺实性结节的疗效研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 58-63.

LI Siyao, BAO Yuhan, LI Xinying, SUN Xiaojing, CAO Xiaoli. Effect of microwave ablation on solid thyroid nodules with different initial volumes[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 58-63.

参考文献

[1] 房居高. 强化手术技能和规范诊疗是提高甲状腺癌疗效的根本[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 1-4. doi:10.6040/j.issn.1673-3770.1.2016.01. FANG Jugao. Operation skill and standard diagnosis and treatment are the basics of improving the curative effect of thyroid carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(2): 1-4. doi:10.6040/j.issn.1673-3770.1.2016.01.
[2] Khanh HQ, Hung NQ, Vinh VH, et al. Efficacy of microwave ablation in the treatment of large(≥3 cm)benign thyroid nodules[J]. World J Surg, 2020, 44(7): 2272-2279. doi:10.1007/s00268-020-05432-2.
[3] Wang B, Han ZY, Yu J, et al. Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation[J]. Int J Hyperthermia, 2017, 33(4): 459-464. doi:10.1080/02656736.2016.1274058.
[4] Gharib H, Papini E, Garber JR, et al. American association of clinical endocrinologists, American college of endocrinology, and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: 2016 update[J]. Endocr Pract, 2016, 22(5): 622-639. doi:10.4158/EP161208.GL.
[5] 葛明华, 徐栋, 杨安奎, 等. 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识(2018版)[J]. 中国肿瘤, 2018, 27(10): 768-773.. doi:10.11735/j.issn.1004-0242.2018.10.A006. GE Minghua, XU Dong, YANG Ankui, et al. Expert consensus on thermal ablation for thyroid benign nodes,microcarcinoma and metastatic cervical lymph nodes(2018 edition)[J]. China Cancer, 2018, 27(10): 768-773. doi:10.11735/j.issn.1004-0242.2018.10.A006.
[6] Wasner GL, Brock JA. Determinants of thermal pain thresholds in normal subjects[J]. Clin Neurophysiol, 2008, 119(10): 2389-2395. doi:10.1016/j.clinph.2008.07.223.
[7] 阎琳, 罗渝昆. 甲状腺结节射频消融疗效影响因素的研究进展[J]. 中华医学超声杂志(电子版), 2020, 17(6): 583-586.doi:10.3877/cma.j.issn.1672-6448.2020.06.018. YAN Lin, LUO Yukun. Progress in understainding factors influencing efficacy of radiofrequency ablation of thyroid nodules[J]. Chinese Journal of Medical Ultrasound(Electronic Edition), 2020, 17(6): 583-586.doi:10.3877/cma.j.issn.1672-6448.2020.06.018.
[8] 王龙琦, 陈坚, 刘绪舜. 微波消融术与传统开放手术在良性甲状腺结节治疗中对机体创伤影响的比较[J]. 中国微创外科杂志, 2016, 16(3): 236-240. doi:10.3969/j.issn.1009-6604.2016.03.012. WANG Longqi, CHEN Jian, LIU Xushun. A comparative study on operative trauma between microwave ablation and traditional open surgery for benign thyroid nodules[J]. Chinese Journal of Minimally Invasive Surgery, 2016, 16(3): 236-240. doi:10.3969/j.issn.1009-6604.2016.03.012.
[9] Park HK, Kim DW, Ha TK, et al. Factors associated with postoperative hypothyroidism after lobectomy in papillary thyroid microcarcinoma patients[J]. Endocr Res, 2015, 40(1): 49-53. doi:10.3109/07435800.2014.933975.
[10] Schneider R, Schneider M, Reiners C, et al. Effects of levothyroxine on bone mineral density, muscle force, and bone turnover markers: a cohort study[J]. J Clin Endocrinol Metab, 2012, 97(11): 3926-3934. doi:10.1210/jc.2012-2570.
[11] Jin H, Fan JR, Liao K, et al. A propensity score matching study between ultrasound-guided percutaneous microwave ablation and conventional thyroidectomy for benign thyroid nodules treatment[J]. Int J Hyperthermia, 2018, 35(1): 232-238. doi:10.1080/02656736.2018.1492028.
[12] Papini E, Pacella CM, Solbiati LA, et al. Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid(MITT)group[J]. Int J Hyperthermia, 2019, 36(1): 376-382. doi:10.1080/02656736.2019.1575482.
[13] Luo FQ, Huang L, Gong XQ, et al. Microwave ablation of benign thyroid nodules: 3-year follow-up outcomes[J]. Head Neck, 2021, 43(11): 3437-3447. doi:10.1002/hed.26842.
[14] Nguyen VB, Nguyen TX, Nguyen VVH, et al. Efficacy and safety of single-session radiofrequency ablation in treating benign thyroid nodules: a short-term prospective cohort study[J]. Int J Endocrinol, 2021, 2021: 7556393. doi:10.1155/2021/7556393.
[15] 章建全, 闫磊, 陈红琼, 等. 甲状腺结节微波消融术后组织病理的动态变化及其临床意义[J]. 第二军医大学学报, 2019, 40(11): 1190-1196. doi:10.16781/j.0258-879x.2019.11.1190. ZHANG Jianquan, YAN Lei, CHEN Hongqiong, et al. Dynamic histopathological changes of thyroid nodule after microwave ablation and its clinical significance[J]. Academic Journal of Second Military Medical University, 2019, 40(11): 1190-1196. doi:10.16781/j.0258-879x.2019.11.1190.
[16] Liu YJ, Qian LX, Liu D, et al. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients[J]. Exp Biol Med(Maywood), 2017, 242(15): 1515-1523. doi:10.1177/1535370217727477.
[17] Zhu YQ, Zhang MB, Jin Z, et al. Solid benign thyroid nodules(>10 ml): a retrospective study on the efficacy and safety of sonographically guided ethanol ablation combined with radiofrequency ablation[J]. Int J Hyperthermia, 2020, 37(1): 157-167. doi:10.1080/02656736.2020.1717647.
[18] Guang Y, He W, Luo YK, et al. Patient satisfaction of radiofrequency ablation for symptomatic benign solid thyroid nodules: our experience for 2-year follow up[J]. BMC Cancer, 2019, 19(1): 147. doi:10.1186/s12885-019-5338-5.
[19] 张颖, 罗渝昆, 广旸, 等. 经皮射频消融治疗甲状腺良性结节的疗效及影响因素[J]. 中华医学超声杂志(电子版), 2018, 15(4): 287-293. doi:10.3877/cma.j.issn.1672-6448.2018.04.010. ZHANG Ying, LUO Yukun, GUANG Yang, et al. The effect and influencing factors of percutaneous radiofrequency ablation for the treatment of benign thyroid nodules[J]. Chinese Journal of Medical Ultrasound(Electronic Edition), 2018, 15(4): 287-293. doi:10.3877/cma.j.issn.1672-6448.2018.04.010.
[20] 胡云飞, 蔡雨, 赵胜. 超声介导微波消融术与传统开放手术比较治疗甲状腺良性结节疗效的系统评价[J]. 中国循证医学杂志, 2019, 19(3): 338-347.doi:10.7507/1672-2531.201807035. HU Yunfei, CAI Yu, ZHAO Sheng. Efficacy of ultrasound-guided percutaneous microwave ablation versus traditional open surgery for benign thyroid nodules: a systematic review[J]. Chinese Journal of Evidence-Based Medicine, 2019, 19(3): 338-347.doi:10.7507/1672-2531.201807035.
[21] 中国医师协会介入医师分会超声介入专业委员会, 中国医师协会介入医师分会肿瘤消融治疗专业委员会, 中国抗癌协会肿瘤消融治疗专业委员会, 等. 甲状腺良性结节解剖位置分类与热消融风险防控专家共识[J]. 中华医学超声杂志(电子版), 2020, 17(1): 6-10. doi:10.3877/cma.j.issn.1672-6448.2020.01.002.
[22] Xia BY, Yu BY, Wang XF, et al. Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules[J]. BMC Surg, 2021, 21(1): 317. doi:10.1186/s12893-021-01312-1.
[23] Lim HK, Lee JH, Ha EJ, et al. Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients[J]. Eur Radiol, 2013, 23(4): 1044-1049. doi:10.1007/s00330-012-2671-3.

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