微波消融和射频消融治疗甲状腺良性结节的疗效和安全性比较

Comparison of efficacy and safety of microwave ablation and radiofrequency ablation for benign thyroid nodules

目的比较超声引导下微波消融(MWA)和射频消融(RFA)治疗甲状腺良性结节的疗效及安全性。方法回顾性分析2018年1月至2020年1月深圳市第三人民医院收治并行超声引导下MWA(56例)和RFA(63例)治疗的119例甲状腺良性结节患者(共187个结节)的临床资料,比较两组患者消融时间、单位体积消融时间、治疗后甲状腺结节体积缩小率、治疗前后甲状腺功能变化、并发症发生率。结果MWA组患者消融时间及单位体积消融时间小于RFA组,差异均有统计学意义(均P<0.05)。治疗后3、6、12个月,MWA组患者结节体积缩小率大于RFA组患者,其中结节>10 ml亚组差异有统计学意义(均P<0.05)。靠近危险三角区域结节的消融中,RFA组患者暂时性声嘶的发生率为6.35(4/63),MWA组为12.50(7/56),但差异无统计学意义(P>0.05)。结论在甲状腺较大结节的消融治疗中,MWA治疗效率、治疗效果优于RFA。对于靠近危险三角区域的甲状腺结节,RFA比MWA安全性更高,但仍需进一步研究证实。

Objective To compare the efficacy and safety of ultrasound-guided microwave ablation(MWA)and radiofrequency ablation(RFA)in the treatment of benign thyroid nodules.Methods The clinical data of 119 patients(187 nodules in total)with benign thyroid nodules who were treated with ultrasond-guided MWA(56 cases)and RFA(63 cases)in Shenzhen Third People′s Hospital from January 2018 to January 2020 were retrospectively analyzed.The ablation time,ablation time per unit volume,volume reduction rate of thyroid nodules after treatment,changes in thyroid function before and after treatment,and incidence of complications were compared between the two groups.Results The ablation time and ablation time per unit volume in the MWA group were significantly shorter than those in the RFA group(all P<0.05).At 3,6,and 12 months after treatment,the reduction rate of nodule volume in MWA group was higher than that in RFA group,and the difference was statistically significant in the subgroup with nodule>10 ml(all P<0.05).The incidence of temporary hoarseness in RFA group[6.35%(4/63)]was lower than that in MWA group[12.5%(7/56)],with no statistically significant difference(P>0.05).Conclusions Microwave ablation is more effective than radiofrequency ablation in the treatment of large thyroid nodules.Radiofrequency ablation is safer than microwave ablation for thyroid nodules near the risk triangle,but further research is needed to confirm.