微波消融术与甲状腺腺叶切除术对BRAF V600E基因野生型cN0甲状腺微小乳头状癌临床效果对比研究

目的探讨微波消融术与甲状腺腺叶切除术对BRAF^V600E基因野生型cN0甲状腺微小乳头状癌（PTMC）的临床效果。 方法选取2017年1月至2019年7月湖北省黄冈市中心医院收治的BRAF^V600E基因野生型cN0-PTMC患者108例，采用随机数字表法分为切除组和消融组，每组54例；切除组行甲状腺腺叶切除术，消融组行微波消融术。比较两组围手术期相关指标、甲状腺功能、术后并发症发生情况及随访情况等。 结果与切除组比较，消融组手术时间、术中出血量、VAS评分、术后住院时间及住院费用显著降低，美观满意度更高（t=27.825、29.693、10.145、15.495、8.152、12.662，均P<0.01）。术后消融组TSH水平较术前显著降低（t=32.457，P<0.001），FT3及FT4水平较术前无显著差异；术后切除组TSH水平较术前显著升高（t=130.517，P<0.001），FT3及FT4水平较术前显著降低（t=28.104、25.641，均P<0.001）；术后两组TSH、FT3及FT4水平比较，差异有统计学意义（t=21.022、6.586、4.659，均P<0.001）。消融组术后总并发症发生率为7.4%，显著低于切除组的22.2%，差异有统计学意义（χ2=4.688，P=0.030）。消融组术前与术后各时间点病灶体积比较差异有统计学意义（W=21.052，P<0.001）。随访期间，两组均未发现病灶复发或远处转移病例。 结论与甲状腺腺叶切除术相比，微波消融术治疗BRAF^V600E基因野生型cN0-PTMC不仅具有微创、恢复快、美观满意度高、并发症少等优势，而且能够更好地保留甲状腺功能，且预后良好，具有较高的临床应用价值。

Comparative study on the clinical effect of microwave ablation and thyroid lobotomy in BRAF V600E wild-type cN0-PTMC

ObjectiveTo investigate the clinical effect of microwave ablation and thyroid lobectomy in small papillary thyroid carcinoma (PTMC) with BRAF^V600E gene wild-type cN0. MethodsA total of 108 patients with BRAF^V600E gene wild-type cN0-PTMC admitted to Huanggang Central Hospital from January 2017 to July 2019 were selected and divided into resection group and ablation group by the random number table method, with 54 patients in each group. Thyroid lobectomy was performed in the resection group and microwave ablation was performed in the ablation group. Perioperative indicators, thyroid function, postoperative complications and follow-up were compared between the two groups. ResultsCompared with the resection group, surgical duration, intraoperative blood loss, VAS score, postoperative hospital stay and hospitalization costs were significantly decreased in the ablation group, and aesthetic satisfaction was higher (t=27.825, 29.693, 10.145, 15.495, 8.152, 12.662, all P<0.01). The postoperative TSH level in ablation group was significantly lower than that before surgery (t=32.457, P<0.001), while the FT3 and FT4 levels had no significant difference compared with that before surgery. The level of TSH in resection group was significantly higher than that before surgery (t=130.517, P<0.001), and the level of FT3 and FT4 was significantly lower than that before surgery (t=28.104, 25.641, both P<0.001). There were statistically significant differences in TSH, FT3 and FT4 levels between the two groups after operation (t=21.022, 6.586, 4.659, all P<0.001). The incidence of total postoperative complications in the ablation group was 7.4%, which was significantly lower than that in the resection group (22.2%) (χ²=4.688, P=0.030). There were significant differences in the volume of lesions between the preoperative and postoperative time points in the ablation group (W=21.052, P<0.001). During the follow-up, no recurrence or distant metastasis was found in both groups. ConclusionCompared with thyroidectomy, microwave ablation for BRAF^V600E gene wild-type cN0-PTMC not only has the advantages of minimally invasion, rapid recovery, high aesthetic satisfaction and less complications, but also can better retain thyroid function, with good prognosis and high clinical application value.