超声引导下微波消融和射频消融与手术切除治疗甲状腺微小乳头状癌的疗效观察

Ultrasound-guided microwave ablation,radiofrequency ablation and surgical resection in the treatment of thyroid micropapilla carcinoma

目的探讨超声引导下微波消融和射频消融与手术切除治疗甲状腺微小乳头状癌的疗效。方法选取2014年5月至2018年2月间南京明基医院收治的227例甲状腺微小乳头状癌患者进行回顾性分析,其中,使用超声引导下微波消融治疗的79例患者纳入A组,使用超声引导下射频消融治疗的75例患者纳入B组,使用手术切除治疗的73例患者纳入C组。观察A、B组患者治疗前后肿瘤直径,比较三组患者甲状腺激素水平、术前术后应激反应和并发症发生情况。结果与治疗前相较,A、B两组患者经过治疗后肿瘤直径均缩小,差异均有统计学意义(均P <0. 05),但组间比较,差异无统计学意义(P <0. 05)。治疗后,A、B两组患者促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)比较,差异无统计学意义(P> 0. 05)。C组TSH指标均高于A、B两组,FT3和FT4指标均低于A、B两组,差异均有统计学意义(均P <0. 05)。术后1d和3d,A、B两组患者肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)比较,差异无统计学意义(P> 0. 05)。C组患者TNF-α和IL-6指标均高于同期A、B两组,差异均有统计学意义(均P <0. 05)。三组患者术后并发症比较,C组患者发生率均高于A、B两组,差异均有统计学意义(均P <0. 05)。结论超声引导下微波消融与射频消融治疗甲状腺微小乳头状癌效果较好,患者肿瘤体积缩小率高,术后甲状腺激素水平稳定,应激反应恢复快,并发症少。

Objective To investigate the efficacy of ultrasound-guided microwave ablation,radiofrequency ablation and surgical resection in the treatment of thyroid micropapilla carcinoma. Methods A total of 227 patients with thyroid micropapilla carcinoma treated at Nanjing Mingji Hospital from May 2014 to February 2018 were selected as the subjects of study. Seventy-nine patients who underwent ultrasoundguided microwave ablation were assigned to group A,75 patients who underwent radiofrequency ablation were assigned to group B and 73 patients who underwent surgical resection were assigned to group C. The tumor size was observed before and after treatment,and the level of thyroid hormone stress reaction and the incidence of postoperative complications were observed before and after treatment. Results After the treatment,the diameter of tumors in group A and B was significantly reduced compared with that before the treatment( all P < 0. 05),but there was no significant difference between the two groups( P > 0. 05). There was no significant difference in thyroid stimulating hormone( TSH),free triiodothyronine( FT3) and free thyroxine( FT4) between group A and B after treatment( P > 0. 05),but TSH index in group C was significant higher in group A and group B and FT3 and FT4 were lower than in group A and group B( all P <0. 05). The levels of tumor necrosis factor-α( TNF-a) and interleukin 6( IL-6) in group A and B were significantly lower than in group A and group B( all P < 0. 05),but the levels of TNF-a and IL-6 in group C were significantly higher than in group A and group B( all P < 0. 05). The overall incidence of symptoms was significantly higher in group C than in group A and group B( P < 0. 05). Conclusion Ultrasoundguided microwave ablation and radiofrequency ablation have significant effects on thyroid micropapilla carcinoma. The tumor volume reduction rate is high,the thyroid hormone level is stable after operation,the stress response recovers quickly and the complications are few.