射频消融治疗甲状腺实性结节642例疗效观察

Efficacy of radiofrequency ablation in the treatment of thyroid solid nodules

目的：探讨射频消融（RFA）治疗甲状腺实性结节的疗效及安全性。方法选取2011年1月至2013年1月我院采用超声引导下射频消融治疗甲状腺实性结节患者64例，随访观察术后肿块体积、结节缩小率、甲功指标等。结果 RFA治疗前患者结节平均大小为（2.52±1.79） cm3，随访6个月后患者的结节平均大小为（0.31±1.02） cm3，治疗前后甲状腺结节变化差异有统计学意义（P＜0.05）；结节缩小率（VRR）平均为（94.52±11.39）%，其中有21例结节完全消失（VRR=100%），治愈率为32.81%；35例VRR＞50%，有效率为54.69%；8例VRR在25%~50%范围内，好转率为12.50%；治疗后1个月检测患者甲功指标，促甲状腺激素（TSH）、血清游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）水平均在正常值范围内，与术前比较差异均无统计学意义（P＞0.05）；治疗前检测患者血清抗甲状腺球蛋白抗体（TG-Ab）和抗甲状腺过氧化物酶抗体（TPO-Ab）分别为（30.54±16.32） IU/ml和（67.52±22.43） IU/ml，术后患者分别为（26.73±17.95） IU/ml和（63.08±27.74） IU/ml，差异均无统计学意义（P＞0.05）；6例患者术中感到颈部疼痛，但均能忍受，停止消融后疼痛即可缓解，有2例患者穿刺部位皮肤红肿，经抗炎治疗后痊愈；未发现皮肤烧伤、血肿、食管穿孔、气管损伤、声音嘶哑、饮水呛咳、神经损伤等并发症。结论射频消融治疗甲状腺实性结节安全和有效，并发症少，无手术疤痕，美容效果好，值得临床推广。

Objective To investigate the efficacy and safety of radiofrequency ablation （RFA） in the treat-ment of thyroid solid nodules. Methods Sixty-four patients with thyroid solid nodules treated by ultrasound-guided radiofrequency ablation （RFA） from January 2011 to January 2013 in our hospital were enrolled in the study. Tumor volume, nodules reduction rate, thyroid function parameters were observed during the follow-up. Results Before treatment, the average size of nodules was （2.52±1.79） cm3. The patients were followed up for 6 months. The average size of nodules after treatment was （0.31 ± 1.02） cm3, showing statistically significant difference compared with that be-fore treatment （P〈0.05）. The average VRR was （94.52 ± 11.39）%, including 21 cases （32.81%） with nodules completely disappeared （VRR=100%）, 35 cases （54.69%） with VRR〉50%, and 8 cases （12.50%） with VRR of 25%~50%. One month after RFA treatment, the thyroid function parameters, TSH, FT3, FT4 levels were all detected to be in the normal range, with no statistically significant difference with those before treatment （P〉0.05）. The serum TG-Ab and TPO-Ab were （30.54±16.32） IU/ml and （67.52±22.43） IU/ml before treatment, （26.73±17.95） IU/ml and （63.08±27.74） IU/ml af-ter treatment, with no statistically significant difference （P〉0.05）. Six patients felt pain in the neck, which is bearable. The pain was alleviated after ablation. Two patients had skin puncture site redness, which was cured after anti-inflam-mation treatment. There was no skin burn, hematoma, perforation of the esophagus, trachea injury, hoarseness, buck-ing, nerve injury and other complications. Conclusion RFA treatment of thyroid nodules is safe and effective, with less complications, no operation scar, good cosmetic effect, which is worth of clinical promotion.