超声引导下射频消融治疗甲状腺微小乳头状癌术后吸收率的影响因素分析  

Analysis of factors related to the absorption rate of papillary thyroid microcarcinoma after ultrasound-guided radiofrequency ablation

作　　者：贾筱夏 常莹[1] 侯文颖 符颖[1] 张会单 杨敬春[1] Jia Xiaoxia;Chang Ying;Hou Wenying;Fu Ying;Zhang Huidan;Yang Jingchun(Department of Ultrasound,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院超声诊断科,北京100053

出　　处：《首都医科大学学报》2023年第6期941-947,共7页Journal of Capital Medical University

基　　金：首都医科大学临床专科学院(系)培养基金开放课题项目(CCMU2023ZKYXY022)。

摘　　要：目的探讨超声引导下射频消融(radiofrequency ablation,RFA)治疗甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的超声和病理特征对术后结节吸收率的影响。方法本研究对2020年12月至2022年3月期间进行超声引导下RFA治疗的PTMC患者进行了回顾性分析。术前收集患者的一般资料,并于术后第1、3、6、12、18个月进行随访,获得结节体积变化情况。以术后结节体积减小百分率(volume reduction ratio,VRR)达到100%的时间作为吸收率评估指标,采用单因素χ2检验及二元Logistic回归分析RFA术后结节吸收率的影响因素。结果本研究对56例接受RFA治疗的PTMC患者的64个结节进行了18个月的随访评估,术后1、3、6、12、18个月随访时结节的平均VRR为61.43%、87.86%、96.62%、99.70%、100%。通过对吸收率相关因素分析发现,结节体积大于0.08 mL以及RFA时间大于130 s与患者术后吸收不良(达到100%VRR时间大于12个月)相关。BethesdaⅢ级的PTMC患者出现术后吸收不良的比例低于BethesdaⅤ/Ⅵ级患者。另外,PTMC患者伴有桥本甲状腺炎与术后低吸收率相关。二元Logistic回归分析显示RFA时长是RFA术后PTMC吸收率的独立影响因素。结论影响超声引导下RFA治疗PTMC术后吸收率的因素包括结节体积、RFA时长、Bethesda分级以及桥本甲状腺炎。RFA时长是RFA术后PTMC吸收率的独立影响因素。Objective To explore the ultrasound and pathological factors related to the absorption rate of ultrasound-guided radiofrequency ablation(RFA)in the treatment of papillary thyroid microcarcinoma(PTMC).Methods This study performed a retrospective analysis of patients with ultrasound-guided RFA for PTMC between December 2020 and March 2022.General information of patients was collected before RFA,and follow-up was performed at 1,3,6,12 and 18 months after RFA to obtain changes in thyroid nodules volume.Taking the time when postoperative nodules reach 100%volume reduction ratio(VRR)as the absorption rate evaluation index,univariateχ2 test and Logistic regression were used to analyze the influencing factors of RFA treatment.Results A total of 64 TNs in 56 patients reached 100%VRR 18 months after RFA,the mean VRR of nodules at 1,3,6,12,and 18 months after RFA were 61.43%,87.86%,96.62%,99.70%and 100%.Through the analysis of ultrasound features,it was found that the nodule volume greater than 0.08 mL and the RFA time longer than 130's were associated with low absorption rate(100%VRR time greater than 12 months).PTMC patients with Bethesda gradeⅢhave a lower rate of absorption than patients with Bethesda classⅤ/Ⅵ.In addition,PTMC patients with Hashimoto's thyroiditis are associated with low absorption rate.Logistic regression analysis showed that RFA was independent influencing factors affecting the rate of absorption after RFA in PTMC patients.Conclusion Ultrasound features affecting the absorption rate of TNs by ultrasound-guided RFA include nodules volume,duration of RFA,Bethesda grade and Hashimoto's thyroiditis.RFA was independent factors of PTMC absorption rate after RFA.

关 键 词：超声引导下射频消融 甲状腺微小乳头状癌 Bethesda分级 桥本甲状腺炎 

分 类 号：R445[医药卫生—影像医学与核医学]