超声引导微波消融与手术治疗甲状腺乳头状微小癌的疗效对比

Effect of ultrasound-guided microwave ablation versus surgery in treatment of thyroid papillary microcarcinoma

目的探讨超声引导微波消融与手术治疗甲状腺乳头状微小癌的疗效差异。方法选取240例甲状腺乳头状微小癌患者作为研究对象,根据患者自愿原则分为观察组和对照组,每组120例。对照组采用常规外科手术治疗,观察组采用超声引导微波消融治疗,比较2组手术情况、应激指标水平、甲状腺指标水平、并发症发生情况及手术疗效。结果观察组手术时间、住院时间短于对照组,术中出血量、住院费用少于对照组,差异均有统计学意义(P<0.05);观察组术后1 d时血清丙二醛(MDA)水平低于对照组,超氧化物歧化酶(SOD)水平高于对照组,差异均有统计学意义(P<0.05);观察组术后1个月时促甲状腺激素(TSH)水平较术前显著降低(P<0.05),游离三碘甲状腺原氨酸(FT 3)、游离甲状腺素(FT 4)水平与术前比较,差异无统计学意义(P>0.05);对照组术后1个月时TSH水平较术前显著升高,FT 3、FT 4水平显著降低(P<0.05);观察组术后并发症总发生率显著低于对照组(P<0.05);术后12个月时,2组均无结节复发、颈部淋巴结转移情况,治疗有效率均为100%;观察组术后3、6、9、12个月时甲状腺结节体积显著小于术前(P<0.05)。结论与甲状腺切除术相比,超声引导微波消融治疗甲状腺乳头状微小癌具有创伤小、应激反应轻、恢复快、并发症少等优点,可较好地保留甲状腺功能,且疗效与手术相似。

Objective To compare effect of ultrasound-guided microwave ablation versus surgery in treatment of thyroid papillary microcarcinoma.Methods A total of 240 patients with thyroid papillary microcarcinoma were selected as research objects,and were divided into observation group and control group according to the principle of patients′willingness,with 120 cases in each group.The operation condition,stress index,thyroid index,complications and surgical effects were compared between the two groups.Results The operation time and hospitalization time in the observation group were significantly shorter than those in the control group,the amount of bleeding and hospitalization expenses in the observation group were significantly less than those in the control group(P<0.05);the serum malondialdehyde(MDA)on the fist postoperative day in the observation group was significantly lower than those in the control group,the superoxide dismutase(SOD)was significantly higher than those in the control group(P<0.05);after 1 month after operation,the thyrotropin(TSH)in the observation group was significantly lower than operation before(P<0.05),there were no significant differences in free triiodothyronine(FT 3)and free thyroxine(FT 4)in the observation group compared to operation before(P>0.05).after operation 1 month,the TSH in control group was significantly higher than that before operation,FT 3 and FT 4 were significantly lower than those before operation(P<0.05);the total incidence of postoperative complications in the observation group was significantly lower than those in the control group(P<0.05);after 12 months of operation,there was no recurrence of nodules and cervical lymph node metastasis in both groups,and the effective rate was 100%;after 3,6,9 and 12 months of operation,thyroid nodule volume was significantly smaller than operation before(P<0.05).Conclusion Compared with thyroidectomy,the ultrasound-guided microwave ablation for papillary thyroid microcarcinoma has the advantages of fewer traumas as well as stress response,faster recovery and fewer complications,and it can better retain thyroid function,and is similar in curative effect to surgery.