经皮射频消融治疗甲状腺良性结节的疗效及影响因素

The effect and influencing factors of percutaneous radiofrequency ablation for the treatment of benign thyroid nodules

目的探讨甲状腺良性结节射频消融治疗的疗效及影响因素,以提高甲状腺良性结节消融治疗的效果。方法选取2013年4月至2016年6月在解放军总医院就诊的甲状腺结节患者468例,甲状腺良性结节482个,其中,女性356个,男性126个,年龄14~82岁,结节最大径0.7~9.2 cm;实性结节258个,囊实性结节224个,甲状腺结节合并桥本氏甲状腺炎96个。甲状腺结节经皮穿刺射频消融术后即刻、1个月、3个月、6个月、12个月、18个月及24个月行常规超声及超声造影检查,观察局部疼痛、红肿、皮肤感染、声音嘶哑等并发症的发生率,同时计算结节的体积缩小率,将结节按照囊实性比例、大小、是否有桥本病背景、性别、年龄进行分组,结节大小、有无桥本、性别、年龄大小分组组间比较采用独立样本t检验,甲状腺结节囊实性比例组间甲状腺结节体积缩小率比较采用方差分析。结果甲状腺良性结节射频消融术后体积明显缩小,术后1个月、3个月、6个月、12个月、18个月及24个月结节体积缩小率分别为:(51.2±5.7)%、(69.7±4.3)%、(84.6±3.7)%、(89.3±2.9)%、(93.7±1.6)%、(94.9±1.4)%;甲状腺结节囊性成分<20%、囊性成分20%~80%、囊性成分>80%3组,术后1、3、6、12、18及24个月组间缩小率比较,差异均有统计学意义(F=66.858、69.101、19.410、49.559、146.653、309.950,P均<0.001),囊性成分比例越高,消融灶缩小越快;将囊性成分<20%的结节,按照最大径≤3 cm及>3 cm、是否有桥本病背景进行分组,术后1、3、6、12、18及24个月组间缩小率比较,差异均有统计学意义(不同大小分组:t=9.710、8.925、9.899、12.734、17.226、42.580;是否有桥本背景分组:t=5.529、7.981、4.843、6.558、17.976、28.906,P均<0.001),3 cm以下、无桥本氏甲状腺炎的结节射频消融后体积缩小更为显著;最大径≤3 cm且囊性成分<20%的结节在性别(男性、女性)、年龄(≤40岁、>40岁)组间,同一随访时间结节的体积缩小率比较,差异均无统计学意义(P均>0.05)。结论经皮射频消融治疗甲状腺良性结节是一种安全、有效的微创治疗方法。

Objective To explore the curative effect and influencing factors of percutaneous radiofrequency ablation （PRFA） for benign thyroid nodules in order to improve the effect of thyroid benign nodule ablation treatment. Methods The study included 482 benign thyroid nodules. The largest diameter of benign thyroid nodules ranges from 0.7 to 9.2 cm. Two hundred and fifty-eight nodules were solid nodules, 224 nodules were cystic-solid nodules, and 96 thyroid nodules combined with the background of Hashimoto′s thyroiditis. The patients of this study included 356 females and 126 males, the ages of the study population ranged from 14 to 82 years old. In order to observe the local pain, swelling, skin infection, hoarseness and other complications of the thyroid nodules with PRFA, we conducted conventional ultrasound and contrast-enhanced ultrasound immediately and followed up in 1, 3, 6, 12, 18 and 24 months after the treatment. Besides, the nodule volume reduction ratio was calculated , and the effects of gender, age, nodule size, cystic proportion, and the background of Hashimoto′s thyroiditis on the treatment were analyzed. Results The volume of benign thyroid nodules after the PRFA treatment was significantly reduced after 1, 3, 6, 12, 18, 24 months, and their nodule volume reduction ratio （VRR） was （51.2±5.7）% （1 months）, （69.7±4.3）% （3 months）, （84.6±3.7）% （6 months）, （89.3±2.9）% （12 months）, （93.7±1.6）% （18 months） and （94.9±1.4）% （24 months）, respectively. The thyroid nodules were divided into 3 groups according to the cystic portion, significant differences were found in the volume reduction rate at 1, 3, 6, 12, 18 and 24 months after PRFA （F=66.858, 69.101, 19.410, 49.559, 146.653 and 309.950 respectively, all P〈0.001）, the more cystic portion was, the faster the lesion shrinked. The nodules with the cystic portion〈20% were grouped according to the maximum diameter （≤3 cm /〉3 cm）, and the background of Hashimoto′s disease; and significant differences were found in the volume reduction rate at 1, 3, 6, 12, 18 and 24 months after PRFA （the t values for different size groups were 9.710, 8.925, 9.899, 12.734, 17.226 and 42.580, respectively, the t values for whether there is a background of Hashimoto′s disease were 66.858, 69.101, 19.410, 49.559, 146.653, 309.950, respectively, all P〈0.001）. The VRR of nodules of which the maximum diameter≤3 cm, or without Hashimoto′s thyroiditis was larger after radiofrequency ablation. The nodules of which the maximum diameter≤3 cm and with the cystic portion 〈20% were grouped according to different genders （male or female） and different ages （≤40 or〉40 years old）, and the mean VRR of the nodules between different gender and age groups are not significantly different （P〉0.05）. Conclusions Ultrasound guided PRFA is a safe and effective minimally invasive therapy for benign thyroid nodules.