超声引导下经皮注射无水乙醇联合微波消融治疗甲状腺良性囊实性肿物

Ultrasound-guided percutaneous ethanol injection combined with microwave ablation for treatment of thyroid benign partially cystic masses

目的观察超声引导下经皮注射无水乙醇(PEI)联合微波消融(MWA)治疗甲状腺良性囊实性肿物的价值。方法前瞻性纳入100例拟接受超声引导下消融治疗的甲状腺单发良性囊实性肿物患者,随机将其均分为PEI组(行PEI联合MWA序贯消融治疗)和对照组(行单纯MWA治疗),观察治疗前、后组内一般资料差异及组间疗效差异,评估序贯消融价值。结果对100个甲状腺肿物均顺利完成超声引导下消融。随访期间PEI组5例、对照组3例失访。PEI组MWA用时、MWA总能量及治疗中患者疼痛程度均低于对照组(P均<0.05)。治疗后1、3、6及12个月,PEI组肿物体积缩小率(VRR)均高于对照组(P均<0.05)。治疗后3、6及12个月,2组肿物体积与治疗前差异均有统计学意义(P均<0.05)。治疗后12个月,PEI组与对照组治疗成功率分别为95.56%(43/45)和89.36%(42/47),组间差异无统计学意义(P=0.451)。治疗后3、6及12个月,2组颈部美观评分及症状评分与治疗前差异均有统计学意义(P均<0.05)。PEI组并发症率为6.67%(3/45),对照组为14.89%(7/47),前者低于后者(P<0.05)。结论超声引导下PEI联合MWA序贯消融治疗甲状腺良性囊实性肿物效果优于单纯MWA。

Objective To observe the value of ultrasound-guided percutaneous ethanol injection(PEI)combined with microwave ablation(MWA)for treating thyroid benign partially cystic masses.Methods A total of 100 patients with single benign partially cystic mass who would undergo ultrasound-guided ablation treatment were prospectively enrolled.The patients were randomly assigned into PEI group(received PEI combined with MWA sequential ablation)or control group(received simple MWA),each n=50.Data before and after treatments were compared within groups,the therapeutic efficacy were compared between groups after treatments,and the value of sequential ablation was analyzed.Results Ultrasound-guided ablation was successfully performed for all 100 masses.During follow-up,5 cases in PEI group and 3 cases in control group were lost.The operation time of MWA,total MWA energy and patients'pain level during treatments in PEI group were all lower than those in control group(all P<0.05).Significant difference of thyroid mass volumes were found before and 3,6 and 12 months after treatments in both groups(all P<0.05).The volume reduction rate(VRR)in PEI group before and 1,3,6 and 12 months after treatments were all higher than that in control group(all P<0.05).The success rate was 95.56%(43/45)in PEI group and 89.36%(42/47)in control group 12 months after treatments,respectively,without significant difference(P=0.451).There were significant differences of neck aesthetics scores and symptom scores before and 3,6 and 12 months after treatments in both groups(all P<0.05).The incidence of complications in PEI group was 6.67%(3/45),while in control group was 14.89%(7/47),the former was lower than the latter(P<0.05).Conclusion Ultrasound-guided PEI combined with MWA sequential ablation had better effect for treating thyroid benign partially cystic masses than single MWA.