无水乙醇提高甲状腺良性实性结节射频消融治疗效率的前瞻性随机对照研究

目的探讨射频消融(RFA)前向甲状腺良性实性结节内注射少量无水乙醇对提高RFA治疗效率的价值。方法 2016年12月至2018年2月,根据标准纳入98例(98个结节)病理确诊为良性的实性结节患者,采用随机数字表法将患者随机分为乙醇消融(EA)联合RFA组(EA+RFA组)和RFA组,每组49例。在治疗前及治疗后1、3、6、12个月进行常规超声、超声造影及甲状腺功能检查,比较两组患者的一般情况、治疗时间、消融能量、消融功率、术后结节体积缩小率(VRR)、症状评分(SS)及外观评分(CS)、甲状腺功能水平和并发症发生率。结果 EA+RFA组平均RFA时间[(441.30±243.31)s比(790.70±349.82)s;t=4.403,P=0.000]、平均消融能量[(3.92±2.01)kJ比(5.15±2.12)kJ;t=2.709,P=0.009]和平均消融功率[(6.07±1.44)W比(7.30±1.29)W;t=3.612,P=0.006]均显著低于RFA组。术后3、6、12个月,EA+RFA组VRR分别为(57.73±11.07)%(t=-3.16,P<0.001)、...

Anhydrous Ethanol Improves Efficiency of Radiofrequency Ablation for the Treatment of Benign Thyroid Nodules:A Prospective Randomized Controlled Trial

Objective To investigate the value of injecting a small amount of absolute ethanol into the benign solid nodules of the thyroid before radiofrequency ablation(RFA)to improve the efficiency of radiofrequency ablation. Methods A total of 98 eligible patients(98 nodules)with pathologically confirmed benign solid nodules who were treated in our center from December 2016 to February 2018 were included and randomized into ethanol ablation(EA)combined with radiofrequency ablation(RFA)group(EA+RFA group)and RFA group,with 49 patients in each group.Routine ultrasound,contrast-enhanced ultrasound(CEUS),and thyroid function test were performed before treatment and 1,3,6,and 12 months after treatment.The general information,treatment time,ablation energy,ablation power,postoperative nodule volume reduction ratio(VRR),symptom score(SS)and cosmetic score(CS),thyroid function level,and incidence of complications were compared between these two groups. Results The mean treatment time [(441.30±243.31)s vs.(790.70±349.82)s;t= 4.403, P=0.000],mean ablation energy [(3.92±2.01)kJ vs.(5.15±2.12)kJ;t=2.709, P=0.009],and mean ablation power [(6.07±1.44)W vs.(7.30±1.29)W;t=3.612, P=0.006] were significantly lower in the EA+RFA group than in the RFA group.At 3,6 and 12 months after surgery,the VRR in the EA+RFA group was(57.73±11.07)%(t=-3.16, P<0.001),(64.40±10.56)%(t=-5.45, P<0.001),and(77.29±8.48)%(t=-10.46, P<0.001),respectively;the VRR in the RFA group was(55.44±13.01)%(t=-1.76, P<0.001),(65.28±11.33)%(t=-5.09, P<0.001),and(75.17±9.84)%(t=-8.93, P<0.001),which were significantly smaller than those before surgery.There was no significant difference in VRR between the EA+RFA group and the RFA group at 1(t=3.41, P=0.33),3(t=2.05, P=0.21),6(t=2.77, P=0.49),and 12 months(t=5.05, P=0.10)after treatment.During the follow-up,no recurrence of nodules was observed on CEUS.In the EA+RFA group,the SS [(1.77±0.86)vs.(5.54±2.15);t=9.63, P<0.001] and the CS[(1.39±0.77)vs.(3.32±0.61);t=10.09, P=0.004]at 12 months after surgery were significantly lower than those before surgery.In the RFA group,SS [(1.63±1.04)vs.(5.90±1.79);t=12.72, P<0.001] and CS [(1.64±0.83)vs.(3.15±0.72);t=8.13, P=0.012] at 12 months after surgery were also significantly lower than those before surgery.The CSS in the EA+RFA group was significantly lower than that in the RFA group [(0.93±0.55)vs.(2.44±0.53);t=-11.70, P=0.007].Both groups had no significant change in thyroid function during the follow-up period,and no serious complications were observed. Conclusion Anhydrous alcohol injection can effectively improve the efficiency of radiofrequency ablation in treating benign solid thyroid nodules and is effective in reducing nodule volume,alleviating compressive symptoms,and decreasing cosmetic discomfort.