超声引导下射频消融术与开放性手术治疗甲状腺良性大结节的疗效比较

Comparison of efficacy between ultrasound-guided radiofrequency ablation and open surgery in the treatment of large benign thyroid nodules

目的 比较超声引导下射频消融术(RFA)与传统开放性手术治疗甲状腺良性大结节的临床疗效。方法 回顾性分析148例甲状腺良性大结节(最大径≥3 cm)患者的临床资料,根据治疗方式将患者分为观察组76例(采用超声引导下RFA治疗)和对照组72例(采用传统开放性手术治疗)。比较两组患者的手术情况,术前、术后3个月的甲状腺激素水平,术后3个月内的并发症发生情况、术后3个月的手术满意度,术后1、6、12、24个月结节体积及术后24个月结节复发情况。结果 (1)观察组患者的手术时间、术后住院时间均短于对照组,术中出血量少于对照组,术后2周的疼痛评分、术后并发症总发生率均低于对照组,手术满意度高于对照组(均P<0.05),而两组患者的结节复发率差异无统计学意义(P>0.05)。(2)观察组患者术后3个月的血清FT3、FT4、TSH水平与术前差异均无统计学意义(均P>0.05),对照组术后3个月的血清FT3、FT4水平较术前及观察组低,血清TSH水平较术前及观察组高(均P<0.05)。(3)观察组患者术后1、6、12、24个月,结节的最大径逐渐缩短、体积逐渐缩小,结节消失数逐渐增多、结节体积缩小率(VRR)逐渐增大,其中术后24个月的VRR为(90.51±2.93)%。结论 采用超声引导下RFA治疗甲状腺良性大结节微创、安全、有效,其治疗效果与开放性手术相当,但对甲状腺功能的影响小,具有较好的临床推广价值,可为甲状腺良性大结节患者提供除手术外的另一种可选择的治疗方案。

Objective To compare the clinical efficacy between ultrasound-guided radiofrequency ablation(RFA) and traditional open surgery in the treatment of large benign thyroid nodules. Methods A retrospective analysis of clinical data was performed in 148 patients with large benign thyroid nodules(maximum diameter ≥3 cm). According to the treatment methods, 76 patients were divided into an observation group(treated with ultrasound-guided RFA), and 72 patients were divided into a control group(treated with traditional open surgery). The surgical conditions, preoperative and 3-month postoperative thyroid hormones levels, occurrence of complications within 3 months after surgery, surgical satisfaction at 3 months after surgery, nodules volume at 1, 6, 12, and 24 months after surgery, and nodules recurrence at 24 months after surgery were compared between the two groups. Results(1) Compared with the control group, patients in the observation group had shorter surgery time and postoperative hospital stay, less intraoperative blood loss, higher 2-week postoperative pain score, lower total incidence of postoperative complications and higher surgical satisfaction(all P<0.05), whereas there was no statistically significant difference in the recurrence rate of nodules between the two groups(P>0.05).(2) There was no statistically significant difference between the 3-month postoperative and preoperative serum FT3, FT4 or TSH levels in the observation group.(all P>0.05), while at 3 months after surgery the serum levels of FT3 and FT4 were lower and the serum TSH level was higher in the control group than those before surgery and those in the observation group(all P<0.05).(3) In the observation group, the maximum diameter of the nodules was gradually shortened, and the volume of nodules was gradually reduced, the number of nodules disappeared was gradually increased, and the nodules volume reduction rate(VRR) was gradually increased at 1, 6, 12, and 24 months after surgery, among which the VRR at 24 months after surgery was(90.51±2.93) %. Conclusion Ultrasound-guided RFA is minimally invasive, safe, and effective in the treatment of large benign thyroid nodules, and its therapeutic effect is comparable to that of open surgery. It has little effect on the thyroid function and good clinical promotion value, thus providing another alternative treatment for patients with large benign thyroid nodules in addition to surgery.