射频消融治疗后甲状腺良性结节疗效的影响因素分析

Factors influencing the efficacy of percutaneous radiofrequency ablation of thyroid benign nodules

目的:探讨超声引导下射频消融(radiofrequency ablation,RFA)治疗甲状腺良性结节疗效的影响因素。方法:回顾并分析2015年12月—2017年12月单次RFA治疗甲状腺良性结节的133例(158个结节)患者的临床资料,于治疗后1、3、6、12个月检测结节体积及体积缩小率(volume reduction rate,VRR),比较不同年龄、性别、初始结节大小(体积)、结节成分、消融功率与时间乘积等因素对疗效的影响。结果:RFA治疗后1、3、6、12个月结节总缩小率分别为(25.65±32.75)%、(57.66±20.88)%、(73.64±19.92)%和(82.21±16.17)%,与治疗前比较差异有统计学意义(P<0.001);初始结节体积与治疗后3、6、12个月VRR呈负相关(P<0.001);治疗后6、12个月囊实性结节平均VRR分别为(84.45±11.98)%和(90.86±10.07)%,高于实性结节(P<0.001);消融时间及消融功率与时间的乘积与治疗后6、12个月结节VRR存在显著相关性(P=0.002和P=0.02);不同年龄、性别与结节VRR无相关性(P>0.05)。结论:超声引导下RFA治疗甲状腺良性结节患者疗效满意,结节的初始体积、实性成分及消融功率与时间乘积将对疗效产生影响。

Objective:To explore the influencing factors of ultrasound-guided radiofrequency ablation(RFA)for benign thyroid nodules.Methods:The clinical data of patients with thyroid benign nodules treated with RFA from December 2015 to December 2017 were retrospectively analyzed.After 1,3,6 and 12 months of treatment,nodule volume and volume reduction rate(VRR)were detected.The effects of different age,sex,initial nodule size(volume),nodule composition,ablation time,power and power-time product on the curative effect were compared.Results:The total VRR of nodules at 1,3,6,and 12 months after RFA were(25.65±32.75)%,(57.66±20.88)%,(73.64±19.92)%,and(82.21±16.17)%,respectively(P<0.001).The initial nodule volume was negatively correlated with VRR of 3,6 and 12 months after RFA(P<0.001).The mean VRR of cystic and solid nodules were(84.45±11.98)%and(90.86±10.07)%,which were higher than those of solid nodules at 6 months and 12 months after RFA(P<0.001).The ablation time and the product of ablation power and time were significantly correlated with the VRR at 6 and 12 months after RFA(P=0.002 and P=0.02).There was no correlation between different age,gender and VRR(P>0.05).Conclusion:Ultrasound-guided RFA of benign thyroid nodules is a safe and effective minimally invasive treatment.Nodule size,solid components,ablation time and the product of ablation power and time are related to VRR after RFA.