超声引导热消融治疗多灶性T_(1)N_(0)M_(0)甲状腺乳头状癌5年以上随访的临床研究

A clinical study of ultrasound-guided percutaneous thermal ablation for multiple T_(1)N_(0)M_(0) papillary thyroid carcinoma with over 5 years follow-up

目的:基于5年以上随访结果评价超声引导热消融治疗多灶性T_(1)N_(0)M_(0)甲状腺乳头状癌(PTC)的有效性和安全性。方法:回顾性分析2014年1月—2019年1月行超声引导下热消融的多灶性T_(1)N_(0)M_(0)期PTC患者68例,分别于消融术后1、3、6、12、24、36、48、60个月比较复发与未复发患者的临床资料、肿瘤超声特征及消融参数,分析热消融治疗多灶性T_(1)N_(0)M_(0)期PTC的疗效及影响因素。结果:5年以上随访,共有11例(16.18%)患者复发,57例(83.82%)患者未复发,无淋巴结转移及远处转移。消融术后复发与患者临床特征、超声表现及消融参数均无显著相关(P>0.05)。复发患者中,1例选择观察,2例选择甲状腺全切术,其余8例均成功接受二次消融,均无不良反应。结论:T_(1)N_(0)M_(0)期多发PTC的消融治疗安全有效,5年以上随访复发率为16.18%,消融不影响复发患者的二次治疗。

Objective:To analyze the safety and efficacy of ultrasound-guided percutaneous thermal ablation treatment for multiple T_(1)N_(0)M_(0) papillary thyroid carcinoma(PTC)with over 5 years follow-up.Methods:From January 2014 to January 2019,a retrospective analysis was conducted on patients with multiple T_(1)N_(0)M_(0) PTC who underwent ultrasound-guided thermal ablation.Patients with bilateral or unilateral lobes with isthmus PTC were enrolled in this study and were followed up at 1,3,6,12,24,36,48,and 60 months after ablation.The clinical data,ultrasound characteristics and ablation parameters of recurrent and non-recurrent patients were compared,and the efficacy and influencing factors of thermal ablation for multiple T_(1)N_(0)M_(0) PTC were analyzed.Results:After over 5 years follow-up,a total of 11 patients(16.18%)relapsed,57 patients(83.82%)did not relapse.No lymph node and distant metastasis were found.No significant correlation was detected between the recurrence and clinical features,ultrasound findings and ablation parameters(P>0.05).Among the patients with recurrence,1 patient underwent observation,2 patients underwent total thyroidectomy,and the other 8 patients successfully underwent secondary ablation,all of which had no obvious adverse reactions.Conclusion:The ablation of multiple PTC in T_(1)N_(0)M_(0) stage is safe and effective,with a recurrence rate of 16.18%over 5 years follow-up,and ablation has no effect on second treatment for recurrent patients.