甲状腺微小乳头状癌经微波消融与手术切除的疗效、安全性及经济性比较

目的比较甲状腺微小乳头状癌患者微波消融与手术切除的疗效、安全性与经济性。 方法选择2014年1月至2017年2月浙江大学医学院附属第二医院经颈部超声检查高度怀疑甲状腺微小乳头状癌，并行超声引导下细针穿刺活检病理确诊为甲状腺微小乳头状癌的89例患者。49例患者行微波消融（微波消融组），40例患者行外科手术（外科手术组）。采用t检验比较2组患者手术时间、住院费用及住院时间；采用χ²检验比较2组患者并发症发生率；采用t检验分别比较2组患者手术前后甲状腺相关激素浓度。 结果微波消融组患者手术时间、住院费用、住院时间均低于外科手术组患者（55.85±5.05）min vs （25.73±9.46）min，（25 435.91±5763.35）元vs （11 307.48±3884.62）元，（6.78±3.03）d vs （2.92±0.78）d]，且差异均有统计学意义（t=-18.985、-13.084、-7.747，P均<0.001）。2组患者均无重要并发症发生，且并发症发生率差异无统计学意义6.1%（3/49）vs 10.0%（4/40），χ²=-0.452，P=0.779]。微波消融组患者术后血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）浓度较术前有所升高，但差异均无统计学意义。外科手术组患者术后FT3、FT4浓度较术前有所降低（4.5±0.50）pmol/L vs （3.90±0.72）pmol/L，（13.94±2.41）pmol/L vs （12.69±2.88）pmol/L]，TSH浓度较术前有所升高（3.66±6.29）mIU/L vs （10.12±15.61）mIU/L]，且差异均有统计学意义（t=6.214，P<0.001；t=2.808，P=0.008；t=-3.035，P=0.004）。 结论超声引导下经皮微波消融治疗甲状腺微小乳头状癌较手术切除创伤小、美观、经济，且疗效确切，为不愿手术切除的患者提供了新的治疗方案。

Microwave ablation and surgical resection of papillary thyroid microcarcinoma: comparative analysis of clinical efficacy,safety and economy

ObjectiveTo compare the efficacy, safety and cost between ultrasound-guided percutaneous microwave ablation and surgical resection in patients with papillary thyroid microcarcinoma. MethodsA total of 89 patients highly suspected papillary thyroid microcarcinoma by cervical ultrasonography were proved by ultrasound guided fine-needle aspiration biopsy in The Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to February 2017. Totally 49 patients underwent microwave ablation (microwave group) while 40 patients underwent surgical resection (surgical group). T test was used to compare operation time, hospitalization expenses and the hospitalization time between the microwave group and the surgical group. Chi-squared test was applied to compare complications rate between the two groups. T test was used to compare the level of thyroid-related hormone before and after operation in the two groups. ResultsIn the microwave group, the operation time, the hospitalization expenses and the hospitalization time were less (55.85±5.05) min vs (25.73±9.46) min, (25435.91±5763.35) CNY vs (11307.48±3884.62) CNY and (6.78±3.03) d vs (2.92±0.78) d]. These differences were statistically significant (t=-18.985, -13.084 and -7.747, P<0.001). No severe complications occurred in the two groups. The difference of complications rate between the two groups was not statistically significant 6.1% (3/49) vs 10.0% (4/40), χ²=-0.452, P=0.779]. The level of 3′-triiodothyronine (FT3) and 4′-triiodothyronine (FT4) were higher after the operation in the microwave group, but these differences were not statistically significant. The level of FT3 and FT4 were lower (4.5±0.50) pmol/L vs (3.90±0.72) pmol/L, (13.94±2.41) pmol/L vs (12.69±2.88) pmol/L], while the level of TSH was higher (3.66±6.29) mIU/L vs (10.12±15.61) mIU/L] after operation in the surgical group. These differences were statistically significant (t=6.214, P<0.001; t=2.808, P=0.008; t=-3.035, P=0.004). ConclusionsUltrasound-guided percutaneous microwave ablation is characterized by minimal invasion, good cosmetic effect, low cost and definite curative effect. It offered a new choice for the patients who refuse to undergo surgical resection.