甲状腺良性结节单次微波消融治疗的短期疗效评价  

Short-term efficacy evaluation of single-session microwave ablation for benign thyroid nodules

作　　者：刘俊松[1] 许崇文[1] 姚小宝[1] 赵瑞敏[1] 汪世洋 赵谦[1] 李宏慧[1] 白艳霞[1] 张少强[1] LIU Junsong;XU Chongwen;YAO Xiaobao;ZHAO Ruimin;WANG Shiyang;ZHAO Qian;LI Honghui;BAI Yanxia;ZHANG Shaoqiang(Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an,Shaanxi,710061,China)

机构地区：[1]西安交通大学第一附属医院耳鼻咽喉头颈外科,陕西西安710061

出　　处：《中国耳鼻咽喉头颈外科》2024年第7期414-420,共7页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金青年项目(82103568);陕西省自然科学基础研究计划(2021JQ-405、2022JM-610)。

摘　　要：目的评价甲状腺良性结节单次微波消融治疗的短期效果。方法选择2019年6月~2022年12月在西安交通大学第一附属医院耳鼻咽喉头颈外科诊治的甲状腺良性结节患者,采用微波消融治疗的连续病例,具有完善的随访数据者纳入分析。治疗后1个月复查甲状腺功能,治疗后3个月、6个月、1年复查超声和甲状腺功能,计算结节体积缩小率(volume reduction rate,VRR)。以1年内末次随访结果为结局变量,纳入性别、年龄、是否合并桥本甲状腺炎、结节纵径、结节实性体积等自变量,进行单因素和多因素分析。结果总计纳入151例患者,共计163个结节,围手术期并发症发生率为1.99%(3/151),治疗后6个月VRR为(79.58±17.70)%,6个月治疗成功率为93.43%(128/137),治疗后1年VRR为(81.24±24.29)%,1年治疗成功率为92.77%(77/83)。单因素及多因素分析显示,结节实性体积和年龄是影响消融后VRR的独立影响因素,年龄的回归系数为0.34,实性体积的回归系数为-0.47,P均<0.05,结节实性体积每增加1 cm3,1年内VRR(%)减少0.47。回归方程:1年内VRR=68.92+0.34×年龄-0.47×实性体积。消融治疗后6个月内血清FT4逐渐下降,促甲状腺激素(TSH)逐渐升高,差异有统计学意义(P<0.05),6个月后FT4逐渐恢复至正常水平,TSH亦逐渐恢复,但至治疗后1年时仍未达到术前水平;治疗后FT3逐渐减低,但各个时间点数值之间差异无统计学意义(P=0.40)。甲状腺结节消融治疗后,甲状腺功能指标平均值出现波动,但均在正常参考范围内。结论甲状腺良性结节微波消融治疗是一种安全有效的治疗方式,其总体治疗成功率可达90%以上。结节实性体积和年龄是影响甲状腺良性结节微波消融效果的独立影响因素。OBJECTIVE To evaluate the short-term efficacy of single-session microwave ablation for benign thyroid nodule.METHODS Patients with benign thyroid nodules treated by microwave ablation between June 2019 and December 2022 at the Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,were included for analysis.Thyroid function was tested 1 month after treatment,and ultrasound and thyroid function were performed 3 months,6 months and 1 year after treatment.Volume reduction rates(VRR)of nodules were calculated.Data of the last follow-up within 1 year were included for analysis.Variables including gender,age,whether Hashimoto's thyroiditis was present,longitudinal diameter of nodules,solid volume of nodules were included for univariate and multivariate analysis.RESULTS A total of 151 patients with 163 nodules were included.The perioperative complication rate was 1.99%(3/151).The VRR at half year after treatment was(79.58±17.70)%,and the success rate at half year after treatment was 93.43%(128/137).The VRR of at 1year after treatment was(81.24±24.29)%.The 1-year treatment success rate was 92.77%(77/83).Univariate and multivariate analysis showed that nodular solid volume and age were independent factors affecting VRR after ablation.Regression coefficient of age and solid volume was 0.34(P<0.05)and-0.47(P<0.05),respectively.For every 1 cm3 increase in solid volume,1-year VRR(%)decreased by 0.47.Regression equation:1-year VRR=68.92+0.34×age-0.47×solid volume.Serum FT4 gradually decreased and the thyroid stimulating hormone(TSH)gradually increased within 6 months after ablation,and the differences were statistically significant(P<0.05).After 6 months,serum FT4 gradually recovered to the normal level and TSH gradually recovered.However,TSH still did not reach the preoperative level one year after ablation.FT3 decreased gradually after treatment,but there was no significant difference between the values at each time point(P=0.40).After the ablation of thyroid nodule,

关 键 词：甲状腺结节 治疗结果 微波消融 实性体积 体积缩小率 结节纵径 

分 类 号：R653[医药卫生—外科学]