不同聚桂醇留置量在甲状腺囊肿硬化治疗中效果分析

Different retained dosage of lauromacrogol within the thyroid cyst in the sclerotherapy of thyroid cysts:an analysis of the curative effect

目的分析评价不同聚桂醇留置量行甲状腺囊肿硬化治疗的效果。方法纳入2020年8月至2021年8月在龙岩市第一医院治疗的200例(200枚)甲状腺囊肿患者,随机分为聚桂醇抽尽组和聚桂醇留置量分别为囊液体积10%、20%、30%、50%组等5组,每组40例。术后1、3、6、12个月复查甲状腺彩色超声,观察分析囊肿硬化后囊腔体积变化、疗效、影响因素及不良反应。采用logistic回归分析影响术后疗效的因素。结果各组抽出液体均呈暗红色,均为囊性结节。术前囊腔体积为(20.43±5.86)cm3。各组手术前后囊腔体积变化显示,术后1个月与术前、术后3个月与术后1个月、术后6个月与术后3个月相比显著缩小(均P<0.05),术后12个月与术后6个月相比相当(P>0.05)。术后6个月各组总有效率为87%(174/200),各组间术后6个月疗效差异无统计学意义(P>0.05)。以术后6个月疗效为因变量,年龄、性别、厚囊壁、囊腔分隔、术前囊腔体积等为自变量,进行二分类logistic回归分析,结果显示厚囊壁(OR=0.24,95%CI=0.08~0.72,P=0.01)、囊腔分隔(OR=0.21,95%CI=0.07~0.67,P=0.01)是影响术后6个月疗效的因素。各组不良反应主要为疼痛,均可忍受,各组不良反应发生率差异无统计学意义(均P>0.05)。结论超声导引下聚桂醇硬化治疗甲状腺囊肿与聚桂醇留置量无关,术后6个月疗效最佳,可作为最佳随访复查时间。厚囊壁及囊腔分隔是影响硬化治疗效果的主要因素。甲状腺囊肿聚桂醇硬化治疗效果确切,不良反应少,值得临床推广应用。

Objective To analyze the effect of different retained dosage of lauromacrogol within the thyroid cyst in the sclerotherapy of thyroid cysts.Methods A total of 200 patients with thyroid cysts,who were admitted to the Longyan Municipal First Hospital of China between August 2020 and August 2021,were enrolled in this study.The patients were randomly and equally divided into group zero(suctioning out all the amount of the injected lauromacrogol),and,according to the percentage of the retained lauromacrogol dosage to the total cystic fluid,group 10%,group 20%,group 30%and group 50%,with 40 patients in each group.Thyroid color ultrasound was reviewed at 1,3,6,and 12 months after treatment.The changes of capsule volume,curative efficacy,influencing factors,and adverse reactions after the cyst became sclerosis were analyzed.Logistic regression analysis was used to analyze the factors affecting the postoperative efficacy.Results In all the 5 groups,the suctioned fluid was dark red in colour,and the patients had cystic nodules.The preoperative mean cyst volume was(20.43±5.86)cm3.In all the 5 groups,the postoperative changes in cyst volume indicated that the postoperative one-month cyst volume significantly shrank when compared with the preoperative volume,the postoperative 3-month cyst volume remarkably shrank when compared with the postoperative one-month volume,and the postoperative 6-month cyst volume strikingly shrank when compared with the postoperative 3-month volume(all P<0.05),while no statistically significant difference in the cyst volume existed between the postoperative 12-month value and the postoperative 6-month value(P>0.05).The postoperative 6-month total effective rate of all the five groups was 87%(174/200),and no statistically significant differences in the postoperative 6-month curative effect existed between each other among the 5 groups(P>0.05).Taking the postoperative 6-month curative effect as the dependent variable,and the age,sex,thick cystic wall,cystic septum,and preoperative cyst volume as independent variables,the binary logistic regression analysis was conducted,which revealed that the thick cystic wall(OR=0.24,95%CI=0.08-0.72,P=0.01)and the cystic septum(OR=0.21,95%CI=0.07-0.67,P=0.01)were the factors affecting the postoperative 6-month curative effect.The main side reaction was pain,which was tolerable by patients.There was no significant difference in the incidence of adverse reactions between each other among the five groups(all P>0.05).Conclusion In treating thyroid cysts by using ultrasound-guided lauromacrogol sclerotherapy,there is no relationship between the curative effect and the percentage of the retained lauromacrogol dosage to the total cystic fluid.The best curative effect can be achieved at 6 months after injection of lauromacrogol,which can be used as the optimal time for follow-up check.The thick cystic wall and the cystic septum are the main factors that affect the curative effect of lauromacrogol sclerotherapy.For the treatment of thyroid cyst,lauromacrogol sclerotherapy carries reliable curative effect with few adverse reactions,therefore,this therapy is worthy of clinical application.