微波消融术和甲状腺腺叶切除术治疗老年甲状腺良性结节的临床疗效比较

Comparison of clinical curative effects of microwave ablation and thyroid lobectomy in the treatment of benign thyroid nodules in the elderly

目的 观察微波消融术和甲状腺腺叶切除术治疗老年甲状腺良性结节对患者疼痛、住院时间及随访复发率的影响,并比较2种术式的疗效。方法 回顾性分析2019年11月—2021年9月在复旦大学附属上海市第五人民医院行手术治疗的老年甲状腺良性结节患者70例,根据手术方式的不同将患者分为微波消融术组(n=42)和甲状腺腺叶切除术组(n=28)。甲状腺腺叶切除术组患者予以甲状腺腺叶切除术治疗,微波消融术组患者予以微波消融术治疗。观察并比较2组的手术相关指标值(手术瘢痕、手术时间及住院时间)及甲状腺功能指标值[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)];采用视觉模拟疼痛评分(VAS)记录并比较2组术后不同时间的疼痛程度;观察并比较2组术后并发症发生情况、术后6个月及1年的复发率。结果 微波消融术组的住院时间和手术时间均明显短于甲状腺腺叶切除术组(P<0.05),手术瘢痕大小小于甲状腺腺叶切除术组(P<0.05)。2组的术前VAS评分差异无统计学意义(P>0.05),2组术后1、3、5 d的VAS评分均低于同组术前(P<0.05),且微波消融术组术后1、3、5 d的VAS评分均显著低于甲状腺腺叶切除术组(P<0.05)。术前,2组FT3、FT4及TSH水平差异均无统计学意义(P>0.05)。术后,2组FT3和FT4水平均低于同组术前(P<0.05),微波消融术组FT3和FT4水平均高于甲状腺腺叶切除术组(P<0.05);2组TSH水平均高于同组术前(P<0.05),微波消融术组TSH水平低于甲状腺腺叶切除术组(P<0.05)。微波消融术组并发症发生率显著低于甲状腺腺叶切除术组(4.76%vs 25.00%,P<0.05)。2组术后6个月及1年的复发率差异均无统计学意义(P>0.05)。结论 2种术式均存在复发风险,但相较于甲状腺腺叶切除术,微波消融术对患者甲状腺功能的影响较小,可缩短住院时间,减小手术瘢痕,降低术后疼痛程度及并发症发生风险,疗效更佳。

Objective To observe the effects of microwave ablation and thyroid lobectomy on the pain,hospitalization time and follow-up recurrence rate in elderly patients with benign thyroid nodules,and compare the curative effects of the two methods.Methods 70 elderly patients with benign thyroid nodules treated by surgical method in Shanghai Fifth People’s Hospital Affiliated to Fudan University from November 2019 to September 2021 were retrospectively analyzed.They were divided into microwave ablation group(n=42) and thyroid lobectomy group(n=28) according to different surgical methods.The patients in the lobectomy group were treated with thyroid lobectomy,and the patients in the microwave ablation group were treated with microwave ablation.The surgical related index values(surgical scar,operation time and hospitalization time) and thyroid function index values [free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)] were observed and compared between the two groups.The Visual Analogue Scale(VAS) was used to record and compare the pain degree at different time after operation between the two groups.The incidence of postoperative complications and the recurrence rate at 6 months and 1 year after operation were observed and compared between the two groups.Results The hospitalization time and operation time of the microwave ablation group were significantly shorter than that of the thyroid lobectomy group(P<0.05),and the surgical scar was smaller than that of the thyroid lobectomy group(P <0.05).There was no significant difference in preoperative VAS scores between the two groups(P> 0.05).The VAS scores of the two groups on the 1 st,3 rd and 5 th day after operation were lower than those of the same group before operation(P<0.05),and the VAS scores of the microwave ablation group were significantly lower than those of the thyroid lobectomy group at the same time(P<0.05).Before surgery,there was no significant difference in the levels of FT3,FT4 and TSH between the two groups(P>0.05).After surgery,the levels of FT3 and FT4 of the two groups were lower than those of the same group before surgery(P<0.05),and the levels of FT3 and FT4 of the microwave ablation group were higher than those of the thyroid lobectomy group(P<0.05);the TSH level of the two groups was higher than that of the same group before operation(P<0.05),and the TSH level of the microwave ablation group was lower than that of the thyroid lobectomy group(P<0.05).The incidence of complications in the microwave ablation group was significantly lower than that in the thyroid lobectomy group(4.76% vs 25.00%,P<0.05).There was no significant difference in the recurrence rate between the two groups at 6 months and 1 year after surgery(P>0.05).Conclusion Both surgical methods have a risk of recurrence.However,compared with thyroid lobectomy,microwave ablation has little effect on the thyroid function of patients.It can shorten the hospitalization time,reduce the surgical scar,reduce the degree of postoperative pain and the risk of complications,and has a better curative effect.