超声引导下微波消融治疗多灶性T1N0M0甲状腺乳头状癌的可行性研究

Ultrasound-guided microwave ablation for multifocal T1N0M0 papillary thyroid carcinoma:a feasibility study

目的研究超声引导下微波消融治疗多灶性T1N0M0甲状腺乳头状癌(PTC)的可行性、安全性和有效性。方法随机纳入2019年1月至2022年1月我院确诊多灶性T1N0M0(≤3个)PTC患者68例为研究对象,肿瘤最大直径≤2 cm,均采用超声引导下微波消融治疗。随访至2023年4月,中位时间为30个月,随访包括常规超声、超声造影、甲状腺功能及必要的细针穿刺细胞学检查(FNA)。结果68例患者分为T1a组52例和T1b组16例,T1b组消融时间显著延长,肿瘤最大直径增加,差异有统计学意义(P<0.05)。68例患者均成功完成手术并康复出院,无明显并发症,超声造影显示消融淋巴结无增强。消融术后1、3、6个月肿瘤最大直径和体积显著大于术前(P<0.05),术后12、18、24个月均逐渐缩小(P<0.05)。随访未出现肿瘤进展或者复发。术前与末次随访甲状腺功能包括甲状腺球蛋白、总甲状腺素和促甲状腺素水平均无显著变化(P>0.05)。结论超声引导下微波消融治疗多灶性T1N0M0的PTC患者有较好的可行性、安全性和有效性。

Objective To investigate the feasibility,safety,and effectiveness of ultrasound-guided microwave ablation in the treatment of multifocal T1N0M0 papillary thyroid carcinoma(PTC).Methods A total of 68 patients with multifocal T1N0M0(≤3 lesions)PTC,whose diagnosis was confirmed at authors'hospital from January 2019 to January 2022,were randomly included as the study subjects.The maximum diameter of tumor was≤2 cm.Ultrasound-guided microwave ablation was carried out in all patients.The patients were followed up until April 2023,with a median time of 30 months.The follow-up examinations included conventional ultrasound,contrast-enhanced ultrasound,thyroid function,and necessary fine needle aspiration cytology(FNA).Results The 68 patients were divided into T1a group(n=52)and T1b group(n=16).The ablation time in T1b group was significantly longer than that in T1a group,and the maximum diameter of tumor in T1b group was significantly larger than that in T1a group,the differences were statistically significant(P<0.05).All 68 patients successfully completed the surgery and were recovered at discharge with no obvious complications.Contrast-enhanced ultrasound imaging revealed that the ablated lymph nodes showed no enhancement.Post-ablation one-,3-and 6-month maximum diameters and volumes of the tumor were significantly larger than their preablation values(P<0.05).Post-ablation 12-,18-and 24-month maximum diameters and volumes of the tumor were gradually decreased(P<0.05).No tumor progression or recurrence was observed during follow-up period.Thyroid function including thyroglobulin,total thyroxine,and thyrotropin,which were determined before ablation and at the last follow-up visit,showed no significant changes(P>0.05).Conclusion For the treatment of T1N0M0 PTC,ultrasound-guided microwave ablation has excellent clinical feasibility,safety,and effectiveness.