超声引导经皮微波消融与腔镜外科手术切除甲状腺乳头状微小癌的对比研究

Comparative study of ultrasound-guided percutaneous microwave ablation and endoscopic thyroidectomy for thyroid papillary microcarcinoma

目的:评估超声引导经皮微波消融(Ultrasound-guided percutaneous microwave ablation,US-PMWA)无影像学检查证明有淋巴结转移的甲状腺乳头状微小癌(Papillary thyroid microcarcinoma,PTMC)的疗效和安全性,并和腔镜下手术治疗作比较。方法:回顾分析US-PMWA治疗PTMC 20例,并于1、3、6、12月后分别接受常规超声、超声造影和甲状腺功能检查,评估消融后的疗效、安全性,并和腔镜下手术组38例的术后住院天数、费用及并发症作比较。结果:US-PMWA的20枚结节体积缩小(19枚缩小>50%,1枚缩小44%),且颈部均未发现可疑转移性淋巴结。US-PMWA前后患者的甲状腺功能指标均在正常参考值范围。消融组术后平均住院天数(1.70±0.57)天,平均住院费用(1 4695.45±1 637.35)元,并发症发生率5.0%(1/20),腔镜下手术组术后住院天数平均(4.78±1.03)天,平均住院费用(2 0596.71±2 192.25)元、并发症发生率10.53%(4/38),两组比较住院天数、费用均有差异(P<0.05),而并发症比较无差异(P>0.05)。结论:US-PMWA治疗PTMC创伤小、美观、恢复快,比较适用于无淋巴结及远处转移的PTMC。

Objective: To evaluate the efficacy and safety of ultrasound-guided percutaneous microwave ablation(US-PMWA) in papillary thyroid microcarcinoma(PTMC), and compare with endoscopic surgery(ET). Methods: Twenty patients with US-PMWA were analyzed retrospectively. Conventional ultrasound, contrast-enhanced ultrasound and thyroid function tests were performed at 1-, 3-, 6-and 12-months to evaluate the efficacy and safety of US-PMWA. Thirty-eight patients underwent endoscopic thyroidectomy for PTMC. The postoperative hospital stay, cost, and complications were compared with each other in two groups. Results: The volume of 20 nodules with US-PMWA reduced during follow-up. No suspicious metastatic lymph nodes were found in the neck. The thyroid function indexes were within normal reference range before and after microwave ablation. The average hospital-stay days, hospitalization costs and complication rate with US-PMWA were(1.70 ±0.57) days,(14 695.45 ±1 637.35) yuan and 5.0%(1/20). The hospital-stay days, hospitalization costs and complication rate with ET were(4.78±1.03) days,(20 596.71±2 192.25) yuan and 10.53%(4/38). The hospitalization days and costs were different between two groups(P<0.05), whereas the complication rate was not(P>0.05). Conclusion: With its minimally invasion, beauty and convenience, US-PMWA is suitable for PTMC without lymph nodes and distant metastasis.