射频消融与手术切除在去除分化型甲状腺癌^(131)Ⅰ治疗前过多残留甲状腺组织的对比研究

Comparison of radiofrequency ablation and operation for overmuch residual thyroid removal before ^(131)Ⅰ treatment in differentiated thyroid cancer

目的比较射频消融与手术切除在去除过多残留甲状腺组织(清甲)的有效性与安全性。方法选取2014年1月至2016年12月浙江省肿瘤医院收治的分化型甲状腺癌术后拟行^(131)Ⅰ治疗患者52例,治疗前低碘饮食及停用优甲乐3周后测血清TSH<30μIU/ml、99mTc甲状腺成像及超声检查提示甲状腺明显残留。28例患者接受射频消融,24例行手术切除。采用t检验比较射频消融与手术切除组的手术时间、^(131)Ⅰ治疗间隔时间及清甲的效果,同时观察2组的并发症情况。结果射频消融组平均用时与手术切除组比较[(22.14±7.12)min vs(55.45±13.56)min],差异有统计学意义(t=11.822,P<0.05)。^(131)Ⅰ治疗前平均等待时间手术切除组与射频消融组比较[(13.53±4.55)d vs(9.40±4.14)d],差异有统计学意义(t=9.144,P<0.05)。RFA组术后出现声音嘶哑、暂时性甲状旁腺损伤、永久性甲状旁腺损伤分别为2例、0例、1例,手术切除组分别为2例、3例、0例,2组间比较,差异均无统计学意义(P均>0.05)。射频消融组^(131)Ⅰ首次清甲成功24例,成功率85.7%,手术切除组成功22例,成功率91.7%,差异无统计学意义(P>0.05)。结论与手术相比,超声引导下射频消融清除分化型甲状腺癌术后残留甲状腺组织同样安全有效,为不愿接受手术切除的患者提供一种新的微创治疗方法。

Objectives The aim of this study is to compare efficacy and safety of radiofrequency ablation versus operation for overmuch residual thyroid removal before ^131I treatment in differentiated thyroid cancer. Methods Clinical data from 52 newly diagnosed differentiated thyroid cancer patients who treated with operation at Zhejiang Cancer Hospital from January 2014 to December 2016 were retrospectively reviewed. The serum TSH was less than 30 IU/ml, and ^99mTc thyroid imaging and ultrasound examination showed obviously residual thyroid tissue after 3 weeks of low iodine diet and discontinuation of euthyrox. Of these patients, 28 cases received radiofrequency, while 24 cases treated with operation. The operation time, the waiting time of 131I treatment and the efficacy of residual thyroid tissue clearance were compared between two groups. At the same time, the complications of the two groups were observed. Results The mean values of operation time between two groups were （22.14±7.12） min and （55.45±13.56） min, respectively, and there was a statistically significant difference （t=11.822, P〈0.05）. The mean waiting time of ^131I treatment in patients received radiofrequency was （9.40±4.14） days, while the mean waiting time in operation group was （13.53±4.55） days, and the differences were statistically significant （t=9.144, P〈0.05）. In RFA group, hoarseness, temporary parathyroid injury and permanent parathyroid injury were observed in 2 cases, 0 case and 1 case, respectively. While there were 2 cases, 3 cases and 0 case in the operative group. There were no significant differences between the two groups （all P〉0.05）. 85.7% （24/28） of patients in RFA group and 91.7% （22/24） in operation group showed favorable efficacy of residual thyroid removal, and there were no significant differences between the two groups （P〉0.05）. Conclusion Compared with operation, postsurgical residual thyroid tissue removal in differentiated thyroid cancer by ultrasound guided radiofrequency ablation by ultrasound guided is safe and effective, and provides a new minimally invasive treatment for patients who are reluctant to undergo surgery.