甲状腺良性大结节射频和微波消融治疗的近期安全性和有效性分析

 目的  探讨甲状腺良性大结节射频消融(radiofrequency ablation, RFA)和微波消融(microwave ablation, MWA)治疗的近期安全性和有效性。方法  选取2016年6月至2017年2月我院采用超声引导下RFA (13例)和MWA (21例)治疗甲状腺良性大结节的患者,随访观察比较两种消融术后甲状腺功能、血清抗体指标变化、并发症和甲状腺结节缩小率(volume reduction rate, VRR)。结果  所有患者治疗前后血清游离三碘甲腺原氨酸(free triiodothyronine, fT3)、游离甲状腺素(free thyroxine, fT4)、促甲状腺激素(thyroid stimulating hormone, TSH)、抗甲状腺球蛋白抗体(anti-thyroglobulin antibodies, TG-Ab)及抗甲状腺过氧化物酶抗体 (thyroid peroxidase antibodies, TPO-Ab)差异均无统计学意义(P＞0.05)。MWA组1例患者术后出现轻度声音嘶哑,RFA组1例出现术中出血10 mL,余患者均未发生颈部瘢痕、术后感染、皮肤灼伤及气管食管损伤等并发症。消融后1天超声造影显示结节均无血供,呈低弱回声;消融后1个月RFA组和MWA组VRR分别为23.8%和22.6%,两者治疗效果差异无统计学意义(P=0.127)。结论  RFA和MWA治疗甲状腺良性大结节安全有效且并发症少,两者近期治疗效果无显著差异。

Short-term safety and efficacy of radiofrequency ablation vs.microwave ablation for patients with large benign thyroid nodules

Objective  To compare the short-term safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of large benign thyroid nodules. Methods  A total of 34 patients with large benign thyroid nodules were studied retrospectively, including 13 patients treated with ultrasound-guided RFA and 21 patients treated with MWA between Jun., 2016 and Feb., 2017 in Zhongshan Hospital. The thyroid function parameters, serum antibodies, complications and thyroid nodules volume reduction rate(VRR) were compared between the two groups during the follow-up. Results  There were no statistically significant differences (P＞0.05) among those patients before and after treatment in serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TG-Ab) levels, and thyroid peroxidase antibodies (TPO-Ab). One patient in the MWA group had mild hoarseness after ablation and another patient in the RFA group had intraoperative hemorrhage for about 10 mL. There were no other complications such as neck scar, postoperative infection, skin burns, tracheal and esophageal injury. One day after the ablation, all nodules were showed hypoecho and contrast-enhanced ultrasound proved there was no blood supply. One month after treatment, no statistically significant difference was found in VRR between two groups (23.8% vs. 22.6%, P=0.127). Conclusions  RFA and MWA are safe and effective treatments for large benign thyroid nodules, and no significant difference was observed in short-term follow-up.