Del Prete S, Russo D, Caraglia M, Giuberti G, Marra M, Vitale G, Lupoli G, Abbruzzese A, Capasso E
Unità Operativa di Oncologia, Ospedale S. Giovanni di Dio, Frattamaggiore, Italy.
Clin Radiol. 2001 Nov;56(11):895-901. doi: 10.1053/crad.2001.0787.
Autonomous thyroid nodules are conventionally treated by surgery or radioiodine. Percutaneous ethanol injection is a recognized alternative approach. An assessment of the long-term success and safety was conducted.
Thirty-four patients (seven men and 27 women; age range: 32-80 years; mean: 56 +/- 13 years) with an autonomous thyroid nodule (ATN) > 40 ml (volume range 41-180 ml; mean: 63.6 +/- 34.5 ml) were treated with ultrasound-guided percutaneous ethanol injection (PEI). All patients were hyperthyroid with increased radionuclide uptake in the nodule at scintigraphy. Serial serum (free T3, free T4 and thyroid-stimulating hormone (TSH)) and ultrasound studies were performed at 3, 6, 12, 18, 24 and 36 months after the first PEI session. Scintigraphy was performed before treatment and 1 month after the serum TSH became detectable or alternatively after 6 months, even if the TSH was still undetectable.
Each patient had 1-11 sessions of PEI, with an injection of 3-14 ml of ethanol per session (total amount of ethanol per patient: 20-125 ml). Within 3 months from the end of the treatment, the recovery of extranodular uptake on isotope scan and the normalization of TSH levels were observed in 30/34 patients. A reduction (average: 62.9%) of nodule volume was recorded in all patients and only 4/34 patients were refractory to PEI. The responsiveness of ATN to PEI appeared to be dependent on the initial nodule volume (3/4 failures in patients had nodule volumes > 60 ml). Side-effects were always self-limiting. During follow-up (6-36 months) no recurrence was observed.
In conclusion, the treatment of ATN > 40 ml with PEI would appear to be a valid alternative approach to traditional methods of treatment. It is safe, well tolerated and inexpensive. Its acceptability when compared with surgery and radiodioine has still to be assessed.
自主性甲状腺结节传统上通过手术或放射性碘进行治疗。经皮乙醇注射是一种公认的替代方法。本研究对其长期疗效和安全性进行了评估。
34例自主性甲状腺结节（ATN）体积>40 ml（体积范围41 - 180 ml；平均：63.6±34.5 ml）的患者（7例男性，27例女性；年龄范围：32 - 80岁；平均：56±13岁）接受了超声引导下经皮乙醇注射（PEI）治疗。所有患者均为甲状腺功能亢进，结节在闪烁扫描时放射性核素摄取增加。在首次PEI治疗后的3、6、12、18、24和36个月进行了系列血清学检查（游离T3、游离T4和促甲状腺激素（TSH））及超声检查。在治疗前以及血清TSH可检测到后1个月或6个月（即使TSH仍未检测到）进行闪烁扫描。
每位患者接受了1 - 11次PEI治疗，每次注射3 - 14 ml乙醇（每位患者乙醇总量：20 - 125 ml）。在治疗结束后的3个月内，30/34例患者的同位素扫描显示结节外摄取恢复，TSH水平恢复正常。所有患者的结节体积均有减小（平均：62.9%），只有4/34例患者对PEI治疗无效。ATN对PEI的反应似乎取决于初始结节体积（4例治疗失败患者中有3例结节体积>60 ml）。副作用均为自限性。在随访期间（6 - 36个月）未观察到复发。
总之，用PEI治疗体积>40 ml的ATN似乎是传统治疗方法的一种有效替代方法。它安全、耐受性好且成本低廉。与手术和放射性碘相比，其可接受性仍有待评估。
