超声引导下微波消融与射频消融治疗甲状腺微小乳头状癌疗效及安全性的对比研究  

Comparison of the efficacy and safety of ultrasound-guided microwave and radiofrequency ablation for the treatment of papillary thyroid microcarcinoma

作　　者：王双龙[1] 吕绍闻 王贝贝[1] 庞慧[1] 高小红[1] 王倩[1] 孔庆锋[1] WANG Shuanglong;LYU Shaowen;WANG Beibei;PANG Hui;GAO Xiaohong;WANG Qian;KONG Qingfeng(Department of Ultrasound,Jining No.1 People's Hospital,Shandong Jining 272000,China)

机构地区：[1]济宁市第一人民医院超声医学科,山东济宁272000

出　　处：《现代肿瘤医学》2025年第6期975-981,共7页Journal of Modern Oncology

基　　金：山东省医务职工科技创新计划联合立项项目(编号:SDYWZGKCJHLH2023074);山东省济宁市科技助推新旧动能转换计划项目(编号:2017SMNS011);山东省济宁市重点研发计划项目(编号:2024YXNS174)。

摘　　要：目的:对比分析超声引导下射频消融与微波消融治疗甲状腺微小乳头状癌的疗效及安全性。方法:回顾性分析我院2020年5月至2023年5月收治并行超声引导下射频消融(radiofrequency ablation,RFA)和微波消融(microwave ablation,MWA)治疗的甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者共220例,根据消融方式分为RFA组(98例)和MWA组(122例),比较两组患者消融时间、水隔离液体用量、术中消融区气化范围(V_(gas))、术后1小时超声造影无增强范围(V1 h)、术中判定与实际消融范围差值(V_(intrao)=V_(gas)-V_(1 h))、术后消融区体积缩小率、并发症发生率以及术后颈部淋巴结转移发生率。结果:两组患者病灶均得到完全消融,两组患者的临床资料及病灶的超声特征差异均无统计学意义(P<0.05);RFA组消融时间、术中判定与实际消融范围差值(V_(intrao)=V_(1 h)-V_(gas))大于MWA组(P<0.05);RFA组水隔离用量、术中消融区气化范围(Vgas)、术后1小时超声造影无增强范围(V1 h)小于MWA组(P<0.05)。RFA组共4例发生声音嘶哑,多于MWA组的2例,差异无统计学意义(P>0.05)。RFA组术后1、3、6、12月消融区体积缩小率均大于MWA组(均P<0.05),随访至12月消融区完全吸收率RFA大于MWA组(P<0.05)。随访期间,RFA组与MWA组各有一例未按要求行TSH抑制治疗的患者经穿刺证实为淋巴结转移。结论:超声引导下RFA及MWA治疗甲状腺微小乳头状癌均是有效且安全的技术;TSH抑制治疗对防止淋巴结转移具有一定的效用;RFA消融区吸收效率更高,但术中根据气化范围判定消融坏死范围不如MWA更准确。Objective:To compare and analyze of the efficacy and safety of ultrasound-guided radiofrequency ablation and microwave ablation for the treatment of papillary thyroid microcarcinoma.Methods:A total of 220 patients with papillary thyroid microcarcinoma(PTMC)treated with ultrasound-guided radiofrequency ablation(RFA)and microwave ablation(MWA)from May 2020 to May 2023 in our hospital were retrospectively analyzed.Patients were 220 cases,which were categorized into the RFA group(98 cases)and the MWA group(122 cases)according to the ablation methods.We compared the ablation time,the amount of water-isolating fluid,the range of vaporization of the ablation zone during the procedure(V_(gas)),the range of nonenhancement of ultrasonography at 1 hour after the procedure(V_(1 h)),the difference between the intraoperative determination and the actual ablation range(V_(intrao)=V_(gas)-V_(1 h)),the rate of volume reduction in the ablation zone after the procedure,the rate of complications,and the postprocedural cervical lymph node metastasis incidence.Results:The lesions in both groups were completely ablated,and the differences in clinical data and ultrasonographic characteristics of the lesions in the two groups were not statistically significant(P<0.05).The ablation time,the difference between intraoperative determination and the actual ablation range(V_(intrao)=V_(1 h)-V_(gas))in the RFA group were greater than those in the MWA group(P<0.05).The amount of water isolation,intraoperative vaporization range of the ablation area(V_(gas)),and the unenhanced range of postoperative ultrasonography at 1 hour(V_(1 h))in the RFA group were smaller than those in the MWA group(P<0.05).The total number of cases of hoarseness occurred in 4 cases in the RFA group,which was more than that of the 2 cases in the MWA group,and the difference was not statistically significant(P>0.05).The volume reduction of the ablation area was larger than that of the MWA group in the RFA group in the 1-,3-,6-,and 12-month periods after the ablation operati

关 键 词：甲状腺微小乳头状癌 射频消融 微波消融 疗效 安全性 对比研究 

分 类 号：R736.1[医药卫生—肿瘤]