超声引导下经皮射频消融治疗原发性甲状旁腺功能亢进效果观察

Effect of ultrasound-guided percutaneous radiofrequency ablation on primary hyperparathyroidism

目的观察超声引导下经皮射频消融治疗原发性甲状旁腺功能亢进症(PHPT)的效果,探讨其安全性。方法2020年1月—2023年3月西安交通大学第二附属医院诊治PHPT患者108例,31例行超声引导下经皮射频消融治疗者为射频消融组,77例行甲状旁腺切除术者为手术切除组,术后均随访1年。比较射频消融组术前与术后1年时甲状旁腺病灶最大径、体积;比较2组术前、术后1年时血清甲状旁腺激素(PTH)、血钙、血磷水平,治疗有效率及随访期间永久性甲状旁腺功能减退症、低钙血症、声音嘶哑等并发症发生率。结果(1)射频消融组术后1年甲状旁腺病灶最大径[(7.89±3.49)mm]、体积[124.32(33.23,219.15)mm3]均小于术前[(20.71±6.39)mm、1444.51(495.27,2494.48)mm3](t=15.619,P<0.001;U=-3.920,P<0.001)。(2)射频消融组术前血清PTH[223.60(102.20,619.90)ng/L]、血钙[2.74(2.37,3.50)mmol/L]、血磷[(0.91±0.15)mmol/L]与手术切除组[191.70(116.95,462.75)ng/L、2.75(2.57,3.00)mmol/L、(0.84±0.20)mmol/L]比较差异均无统计学意义(U=-0.434,P=0.664;U=-0.168,P=0.867;t=1.573,P=0.119),术后1年血清PTH[53.00(49.01,66.02)ng/L]、血钙[2.31(2.23,2.34)mmol/L]、血磷[(1.13±0.11)mmol/L]与手术切除组[58.00(49.50,71.01)ng/L、2.33(2.20,2.38)mmol/L、(1.10±0.12)mmol/L]比较差异均无统计学意义(U=-0.693,P=0.489;U=-0.045,P=0.964;t=1.085,P=0.281)。射频消融组、手术切除组术后1年血清PTH(U=-4.197、-7.578,P均<0.001)、血钙(U=-3.924、-7.575,P均<0.001)水平均低于术前,血磷水平均高于术前(t=-9.888、-12.413,P均<0.001)。(3)射频消融组术后1年治疗有效率(90.32%)与手术切除组(93.51%)比较差异无统计学意义(χ^(2)=2.326,P=0.348)。(4)射频消融组轻度低钙血症发生率(9.68%)低于手术切除组(28.57%)(P=0.044),声音嘶哑(6.45%)、永久性甲状旁腺功能减退症(0)、重度低钙血症(3.23%)发生率与手术切除组(10.39%、1.30%、6.49%)比较差异均无统计学意义(P>0.05)。结论超声引导下经皮射频消融治疗PHPT的短期疗效与甲状旁腺切除术相近,可减少术后并发症。

Objective To observe the effect of ultrasound-guided percutaneous radiofrequency ablation in the treatment of primary hyperparathyroidism(PHPT)and to explore its safety.Methods From January 2021 to March 2023,108patients with PHPT were treated in the Second Affiliated Hospital of Xi'an Jiaotong University,among whom 31 patients underwent ultrasound-guided percutaneous radiofrequency ablation(radiofrequency ablation group)and 77 patients underwent parathyroidectomy(parathyroidectomy group).All patients were followed up for 1 year after surgery.The maximum diameter and volume of parathyroid lesion were compared in radiofrequency ablation group before and 1 year after surgery.The serum levels of parathyroid hormone(PTH),calcium and phosphorus,effective rate,and rate of complications as permanent hypoparathyroidism,hypocalcemia and hoarseness during follow-up were compared between two groups before and 1 year after surgery.Results(1)The maximum diameter and volume of parathyroid lesion were significantly lower in radiofrequency ablation group 1 year after surgery[(7.89±3.49)mm,124.32(33.23,219.15)mm^(3)]than those before surgery[(20.71±6,39)mm,1444.51(495.27,2494.48)mm^(3)](t=15.619,P<0.001;U=-3.920,P<0.001).(2)There were no significant differences in the levels of serum PTH,calcium and phosphorus before surgery between radiofrequency ablation group[223.60(102.20,619.90)ng/L,2.74(2.37,3.50)mmol/L,(0.91±0.15)mmol/L]and parathyroidectomy group[191.70(116.95,462.75)ng/L,2.75(2.57,3.00)mmol/L,(0.84±0.20)mmol/L](U=-0.434,P=0.664;U=-0.168,P=-0.867;t=1.573,P=0.119).There were no significant differences in the levels of serum PTH,calcium and phosphorus 1 year after surgery between radiofrequency ablation group[53.00(49.01,66.02)ng/L,2.31(2.23,2.34)mmol/L,(1.13±0.11)mmol/L]and parathyroidectomy group[58.00(49.50,71.01)ng/L,2.33(2.20,2.38)mmol/L,(1.10±0.12)mmol/L](U=-0.693,P=0.489;U=-0.045,P=0.964;t=1.085,P=0,281).The levels of serum PTH(U=-4.197,-7.578;all P values<0.001)and calcium(U=-3.924,-7.575;all P values<0.001)in radiofrequency ablation group and parathyroidectomy group1 year after surgery were lower than those before surgery,and the serum phosphorus levels were higher than those before surgery(t=-9.888,-12.413;all P values<0.001),(3)The effective rate 1 year after surgery in radiofrequency ablation group(90.32%)was not statistically different from that in parathyroidectomy group(93.51%)(χ^(2)=2.326,P=0.348).(4)The rate of mild hypocalcemia was lower in radiofrequency ablation group(9.68%)than that in parathyroidectory group(28.57%)(P=-0.044),and the rates of hoarseness,permanent hypoparathyroidism and severe hypocalcemia showed no significant differences between radiofrequency ablation group(6.45%,0,3.23%)and parathyroidectomy group(10.39%,1.30%,6.49%)(P>0.05).Conclusion Ultrasound-guided percutaneous radiofrequency ablation can achieve similar short-term effect to parathyroidectomy in the treatment of PHPT,and it can reduce the rate of complications after surgery.