超声引导下射频消融治疗甲状腺实性结节的疗效

Efficacy of ultrasound-guided radiofrequency ablation on solid thyroid nodules

目的探讨超声引导下射频消融(RFA)治疗甲状腺实性结节的疗效。方法回顾性分析于新乡市中心医院2016年12月至2018年12月接受超声引导下RFA治疗的43例甲状腺实性结节(65枚结节)患者的临床资料。记录所有患者术后3个月及6个月的临床疗效,术前、术后1个月的甲状腺功能[血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、血清促甲状腺激素(TSH)]变化、超声影像及并发症发生情况。结果治疗3个月后,其治愈率为4.7%(2/43),显效率为37.2%(16/43),好转率为41.9%(18/43),而治疗6个月后,其治愈率为20.9%(9/43),显效率为51.2%(22/43),好转率为27.9%(12/43);术后1个月,所有患者的FT3、FT4、TSH水平与术前比较差异未见统计学意义(P>0.05);术后2 d经过超声检查,发现其65枚结节均呈现低回声,其中14枚结节回声欠均,具有点状强回声,形态规整边界清晰,结节内部无明显血流信号;术后患者仅少数出现声音嘶哑及颈部神经放射性疼痛,且无需干预即可恢复。结论超声引导下RFA可显著改善甲状腺实性结节患者的甲状腺功能,具有较为理想的治疗效果,且术后并发症发生率低,安全性高。

Objective To investigate the efficacy of ultrasound-guided radiofrequency ablation(RFA)on solid thyroid nodules.Methods The clinical data of 43 patients with solid thyroid nodules(65 nodules)who underwent ultrasound-guided RFA in the Central Hospital of Xinxiang from December 2016 to December 2018 were retrospectively analyzed.The clinical efficacy at 3 and 6 months after surgery,changes in thyroid function[serum free triiodothyronine(FT3),serum free thyroxine(FT4),serum thyroid stimulating hormone(TSH)]before surgery and at 1 month after surgery,ultrasound images and complications were recorded.Results After 3 months of treatment,the cure rate,markedly effective rate and improvement rate were 4.7%(2/43),37.2%(16/43)and 41.9%(18/43).After 6 months of treatment,the cure rate,markedly effective rate and improvement rate were 20.9%(9/43),51.2%(22/43)and 27.9%(12/43).At 1 month after surgery,there were no significant changes in the levels of FT3,FT4 or TSH compared with those before surgery(P>0.05).After 2d of surgery,ultrasound examination revealed that 65 nodules showed low echo,and 14 nodules of them showed uneven echoes,with strong point-like echoes,regular shape and clear boundaries and no obvious blood flow signals inside the nodules.Only a few patients were with hoarse voice and cervical nerve radioactive pain after surgery,and they could recover without intervention.Conclusions Ultrasound-guided RFA can significantly improve the thyroid function of patients with solid thyroid nodules.It has an ideal therapeutic effect,and has low incidence rate of postoperative complications and high safety.