微波消融治疗不同初始体积甲状腺实性结节的疗效研究

Effect of microwave ablation on solid thyroid nodules with different initial volumes

目的探讨微波消融治疗不同初始体积甲状腺实性结节的有效性及安全性。方法回顾性分析超声引导下微波消融治疗的68例患者82个甲状腺良性结节,消融术后第1、3、6、12个月随访复查,计算体积缩小率(VRR)及并发症情况。将结节按照初始体积分为>12cm^(3)、9~12cm^(3)、4~8cm^(3)及<4cm^(3)四组,比较四组结节消融治疗有效性及安全性。结果甲状腺实性结节微波消融术后体积较术前呈进行性缩小,术后1、3、6、12个月VRR分别为(37.93±19.48)%、(61.69±14.76)%、(74.27±12.93)%、(84.92±10.35)%,差异有统计学意义(P<0.05)。体积>12cm^(3)组结节与9~12cm^(3)、4-~8cm^(3)及<4cm^(3)组比较,消融时间长、消融能量大,术中疼痛评分高,差异有统计学意义(P<0.05)。术后1个月体积>12cm^(3)组与<4cm^(3)组结节VRR低于其他两组,差异无统计学意义(P>0.05)。术后3、6、12个月体积>12cm^(3)结节VRR最低,差异有统计学意义(P<0.05)。术后结节复发率14.6%(12/82),1例患者一过性声音嘶哑,无饮水呛咳等严重神经损伤并发症。结论微波消融治疗甲状腺实性结节安全有效,结节初始体积对疗效有一定影响,相对体积较小结节疗效更显著。

Objective This research aimed to investigate the effects of ultrasound-guided microwave ablation(MWA)on benign solid thyroid nodules with different initial volumes.Methods Eighty-two benign solid nodules that had received MWA were divided into four groups according to the initial volume(>12,9-12,4-8,and<4 cm^(3)).The ablation parameter and volume reduction rate(VRR)for the four groups were calculated,and the recurrence rate and complication rate were recorded.Results The volume of nodules gradually reduced after 1,3,6,and 12 months;the VRR was 37.93±19.48%,61.69±14.76%,74.27±12.93%and 84.92±10.35%,respectively(P<0.05).Compared with those of other groups,for the initial volume≥12 cm^(3) group,the ablation time was longer and ablation power was higher(P<0.05);the pain score was higher(P<0.05);and the VRR was significantly lower at 3,6,and 12 months(P<0.05).The recurrence rate was 14.6%(12/82).One case of transient hoarseness was recorded in the largest volume group.Conclusion Microwave ablation is a safe and effective treatment for benign solid thyroid nodules,and the curative effect of relatively small nodules is more significant.