甲状腺疾病射频消融治疗现状与争议

The current situation and controversy of radiofrequency catheter ablation for thyroid diseases

近年来,超声引导下射频消融技术已被应用于甲状腺良性结节及不可手术的复发甲状腺癌。然而,甲状腺疾病的射频消融治疗存有争议。射频消融的操作者在熟练掌握操作技巧、颈部解剖及甲状腺疾病相关的理论基础上更要严格把握其应用指征。甲状腺良性结节的治疗中射频消融不被推荐作为常规手段,无症状者无须行侵入性处理;另外消融技术由于缺乏相关安全性、有效性的循证医学证据,分化型甲状腺癌的治疗中射频消融更不能作为其初始治疗手段,只有当病人病情较重无法手术或身体条件无法耐受手术时,才可将射频消融作为可选方案。甲状腺结节无论良恶性,凡具有手术指征,均应将手术作为首选治疗方案。国内多家甲状腺治疗中心均报道了一批射频消融后甲状腺癌残留再次手术的病例。对于消融后再手术的甲状腺癌病人,由于手术风险难度增加,手术方法可部分参考局部晚期的甲状腺癌病人诊治策略,建议由经验丰富的甲状腺外科医生实施来降低手术并发症发生率。

In recent years, ultrasound-guided radiofrequency ablation has been applied to benign thyroid nodules and unresectable recurrent thyroid cancer. However, radiofrequency ablation in thyroid disease remains controversial. Radiofrequency ablation operators should master the application indications on the basis of proficiency in basic skills of operation, neck anatomy and thyroid disease. Radiofrequency ablation is not recommended as a routine measure in the treatment of benign thyroid nodules and invasive treatment is not necessary for asymptomatic patients. Due to the lack of evidence of safety and effectiveness, radiofrequency ablation is not the initial treatment method for differentiated thyroid cancer. It can only be used as an alternative for patients with strong rejection of operation, severe illness and intolerance of operation. Whether thyroid nodules are benign or malignant, surgery should be the preferred treatment if there is an indication of surgery. Several domestic thyroid treatment centers have reported a number of cases with re-operation of residual thyroid cancer after radiofrequency ablation. For patients with thyroid cancer who underwent reoperation after ablation, surgical procedures may be partially referenced to the diagnosis and treatment strategies of patients with locally advanced thyroid cancer due to the increased surgical risk. It is recommended that experienced thyroid surgeons implement surgical procedures to reduce complications.