超声引导下微波消融治疗原发性甲状旁腺功能亢进症的效果

Ultrasound-guided microwave ablation for primary hyperparathyroidism

目的观察超声引导下微波消融(MWA)治疗原发性甲状旁腺功能亢进症(PHPT)的有效性及安全性。方法回顾性分析96例接受超声引导下MWA及术后规律随访的PHPT患者。术后6个月评价治疗效果,计算病灶体积缩小率。对比术前与术后6个月血清全段甲状旁腺激素(iPTH)、钙及磷,记录不良反应。结果96例患者共109个PHPT病灶,均获完全消融。术后随访7~43个月,中位随访时间18.5个月。术后6个月85例血清iPTH及钙在正常值范围内,治愈率为88.54%(85/96);9例(9/96,9.38%)持续性PHPT,2例(2/96,2.08%)复发性PHPT。术后6个月血清iPTH、钙较术前降低,磷较术前升高(P均<0.01)。术后6个月病灶体积缩小率为74.20%。1例术中出现局部血肿,经按压局部后止血;5例术后出现声音嘶哑,经对症处理后6个月内均恢复;24例出现一过性甲状旁腺功能减退,13例手部麻木,3例一过性低钙血症,1例头痛,均未经特殊处理后好转。结论超声引导下MWA治疗PHPT安全、有效。

Objective To observe the efficacy and safety of ultrasound-guided microwave ablation(MWA)in treatment of primary hyperparathyroidism(PHPT).Methods Ninety-six PHPT patients who underwent ultrasound-guided MWA and regularly followed-up after treatment were retrospectively analyzed.The therapeutic effect was evaluated 6 months after ablation,and the volume reduction rate(VRR)was calculated.The serum intact parathyroid hormone(iPTH),calcium and phosphorus were compared before and 6 months after MWA.The complications of MWA were recorded.Results A total of 109 lesions in 96 PHPT patients were completely ablated.The follow-up time was 7-43 months,and the median follow-up time was 18.5 months.Six months after MWA,the serum iPTH and calcium levels of 85 patients were within normal ranges,and the cure rate was 88.54%(85/96).There were 9 cases(9/96,9.38%)of persistent PHPT and 2 cases(2/96,2.08%)of recurrent PHPT.The serum iPTH,calcium and phosphorus levels were improved 6 months after MWA(all P<0.01).Six months later,the volume reduction rate(VRR)of the ablation zone was 74.20%.Local hematoma occurred in 1 patient during ablation,and bleeding stopped after local compression.Hoarseness occurred in 5 cases after ablation,but recovered within 6 months after symptomatic treatment.There were 24 cases of transient hypoparathyroidism,13 cases of hand numbness,3 cases of transient hypocalcemia and 1 case of headache,all recovered spontaneously without special treatments.Conclusion MWA was safe and effective for treatment of PHPT.