射频消融术与外科手术治疗甲状腺乳头状微小癌的临床价值对比

Comparison of clinical value of radiofrequency ablation and surgical treatment for papillary thyroid carcinoma

目的对比超声引导下射频消融(RFA)与外科手术治疗甲状腺乳头状微小癌(PTMC)的疗效以及并发症。方法选择2012年1月至2017年10月鄂尔多斯东胜区人民医院及鄂尔多斯市中心医院收治的PTMC 171例,分为射频消融组84例,外科手术组87例。观察两组的手术时间、术中出血量、住院时间、术后24 h血清C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、术后7 d、术后30 d甲状腺相关激素变化以及并发症情况。结果外科手术组的手术时间、术中出血量、住院时间明显高于射频消融组,CRP、IL-6、TNF-α水平明显高于射频消融组,差异有统计学意义(均P<0.05)。外科手术组术后游离三碘甲状腺原氨酸(FT3)(2.77±0.69)pmol/L、游离甲状腺素(FT4)水平(9.39±2.16)pmol/L低于RFA组[FT3:(4.22±0.35)pmol/L,FT4:(12.74±2.37)pmol/L,促甲状腺激素(TSH)水平(18.56±2.42)mIU/L]高于射频消融组(1.03±1.44)mIU/L,差异有统计学意义(均P<0.05)。交互作用显示FT3、FT4、TSH术后7 d和30 d的变化与治疗方案存在交互作用(均P<0.05)。射频消融组术后并发症发生率(2.4%)明显低于外科手术组(25.3%),差异有统计学意义(P<0.05)。结论与外科手术治疗相比,RFA治疗PTMC对机体创伤较小,能有效缩短病人住院时间。

Objective To compare the efficacy and complications of ultrasound-guided radiofrequency ablation(RFA)with surgical resection for thyroid papillary microcarcinoma(PTMC).MethodsA total of 171 patients with PTMC who admitted to Dongsheng People’s Hospital and Ordos Central Hospital from January 2012 to October 2017 were selected and assigned into two groups,including 84 patients in the RFA group and 87 patients in the surgery group.The operation time,intraoperative blood loss,hospital stay,24 h postoperative serum C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),and changes in thyroid-related hormones and complications at 7 and 30 days after surgery were observed.ResultsThe operation time,intraoperative blood loss and hospitalization time in the surgery group were significantly higher than those in the RFA group.The levels of CRP,IL-6 and TNF-αwere significantly higher than those in the RFA group(P<0.05).The levels of free Triiodothyronine(FT3)(2.77±0.69)pmol/L and free Thyroxine(FT4)(9.39±2.16)pmol/L in the surgery group were lower than those in the RFA group FT3(4.22±0.35)pmol/L,FT4(12.74±2.37)pmol/L,and the level of thyroid stimulating hormone(TSH)(18.56±2.42)mIU/L was higher than that in the RFA group(1.03±1.44)mIU/L(P<0.05).The interaction showed that there was an interaction between the treatment protocols and the changes of FT3,FT4 and TSH at 7 d and 30 d after treatment(P<0.05).The incidence of postoperative complications in the RFA group(2.4%)was significantly lower than that in the surgical group(25.3%),and the difference was statistically significant(P<0.05).ConclusionCompared with surgery,RFA treatment of PTMC has less trauma to the body and can effectively shorten the length of hospital stay.