微波消融与手术切除甲状腺微小乳头状癌的短期疗效及对患者生活质量的影响  

Short-term Effect and Life Quality of the Patients About Microwave Ablation and Surgical Resection for Papillary Thyroid Microcarcinoma

作　　者：陈吉东[1] 岳林先[1] 张惠 顾毅[2] 吴昊[1] Chen Jidong;Yue Linxian;Zhang Hui;Gu Yi;Wu Hao(Ultrasonic Medical CenterAcademy of Medial Sciences&Sichuan Provincial People’s Hospital,Chengdu,Sichuan 610072,China;Vascular Thyroid Surgery,Academy of Medial Sciences&Sichuan Provincial People’s Hospital,Chengdu,Sichuan 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院超声医学中心,成都市610072 [2]四川省医学科学院·四川省人民医院血管甲状腺外科,成都市610072

出　　处：《中国超声医学杂志》2021年第7期741-745,共5页Chinese Journal of Ultrasound in Medicine

基　　金：四川省科技厅重点研发项目(No.2020YFS0406)。

摘　　要：目的探讨微波消融与手术切除低风险甲状腺微小乳头状癌(PTMC)的短期疗效及对患者生活质量的影响,为临床治疗提供依据。方法回顾性分析经病理证实的157例单发低风险PTMC患者的临床资料,根据患者意愿分为消融组和切除组,消融组75例,行经皮微波消融;切除组82例,行开放式手术切除。观察消融组病灶缩小率及消失率,对比观察两组有效率、操作时间、住院时间、激素水平、并发症、局部复发率、新发率、淋巴结转移率及患者的生活质量健康调查简表(SF-36)评分。结果两组有效率均为100%,均无局部复发。第1、第3、第6、第12、第24个月,消融组组内比较病灶缩小率差异有统计学意义(P<0.05),消失率分别为0、0、16.00%、41.33%、93.33%。组间比较操作时间、住院时间、激素水平及并发症差异均有统计学意义(P<0.05),新发率及淋巴结转移率差异无统计学意义(P=0.13,P=0.08)。治疗前后不同组别和不同时间点的躯体健康得分(PCS)差异无统计学意义(P>0.05);组间比较治疗后各时间点消融组心理健康得分(MCS)和生活质量(SF-36)总分高于切除组,差异有统计学意义(P<0.05)。结论微波消融和外科切除均能安全有效治愈低风险PTMC,微波消融更微创高效且并发症更少,更能提升患者的生活质量,故微波消融有望成为该类患者的另一种治愈替代方案。Objective To investigate the effect of microwave ablation and surgical resection on low-risk Papillary thyroid microcarcinoma(PTMC)and its impact on patients′ life quality, in order to provide the basis for the selection of clinical treatment. Methods The clinical data of 157 patients with PTMC confirmed by pathology were analyzed retrospectively. According to patients′ wishes, they were divided into ablative group and resection group, and 75 patients in ablative group were treated with percutaneous microwave ablation. In the resection group, 82 patients underwent open surgical resection. The reduction rate and disappearance rate of the lesion in the ablation group were observed. In two groups, the effective rate, treatment operation time and length of stay in hospital, hormone levels, complications, local recurrence rate, the rate of new occurrence and lymph node metastasis rate were compared, and the score of 36-item Short Form Health Survey(SF-36) Scale was compared. Results The effective rate of the two groups was 100%, and there was no local recurrence. At the first, third, sixth, 12 th and 24 th months after treatment, the reduction rate of lesions in the ablation group was statistically significant(P<0.05),and the disappearance rate of lesions was 0, 0,16.00%, 41.33% and 93.33%,respectively.There were statistically significant differences in operation time, length of hospital stay, hormone levels and complications(P<0.05).There was no statistically significant difference between groups in the rate of new occurrence and lymph node metastasis(P=0.13,P=0.08).There was no significant difference in the total PCS of different groups and time points before and after treatment(P>0.05).After treatment, the total scores of MCS and SF-36 in the ablation group were higher than those in the resection group at each time point, with statistically significant differences(P<0.05). Conclusions Both microwave ablation and surgical resection can safely and effectively cure low-risk PTMC, and ablation is more minimally inv

关 键 词：甲状腺微小乳头状癌 微波消融 手术切除 疗效 生活质量 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]