Goletti O, Monzani F, Caraccio N, Del Guerra P, Lippolis P V, Pucciarelli M, Seccia M, Carmassi F, Cavina E, Baschieri L
Department of Emergency Surgery, University of Pisa, Italy.
World J Surg. 1992 Jul-Aug;16(4):784-9; discussion 789-90. doi: 10.1007/BF02067387.
Twenty-five patients with solitary autonomous thyroid nodules (15 nontoxic, 10 toxic) received percutaneous ethanol injection treatment (PEIT) under sonographic guidance in 4-7 sessions (1-2 weekly). To test different doses, smaller nodules (volume less than 15 mL) were given 0.75-2.8 mL ethanol/mL nodular tissue while larger nodules received 0.5-1 mL/mL. Except for 1 patient who developed hyperpyrexia, no relevant adverse effects were observed. A slight, asymptomatic increase in serum thyroid hormone levels was observed in both groups during the treatment. Three months after treatment, a biochemical and clinical remission of hyperthyroidism was observed in 8 of 10 patients with toxic nodules. A significant increase of TSH level was seen in both groups (p less than 0.01). Significant shrinkage of volume (p less than 0.001) as well as structural alterations of nodules were consistently recorded at sonography. A linear relationship (r = 0.98; p less than 0.0001) between pretreatment volume and volume reduction was found both for large and small nodules, thus suggesting that even limited ethanol doses may be therapeutically effective. A recovery of extranodular parenchyma activity at scintiscan occurred in 16 (64%) of 25 patients. These data confirm that PEIT is effective in obtaining functional ablation and in inducing remission of hyperthyroidism. Adverse effects are infrequent. In spite of the small patient sample, a 0.5-1 mL ethanol dose per each mL of tissue appears as effective as larger doses and seems appropriate for treatment.
25例孤立性自主性甲状腺结节患者（15例为非毒性结节，10例为毒性结节）在超声引导下接受经皮乙醇注射治疗（PEIT），共进行4 - 7次治疗（每周1 - 2次）。为测试不同剂量，较小的结节（体积小于15 mL）给予0.75 - 2.8 mL乙醇/ mL结节组织，而较大的结节给予0.5 - 1 mL/ mL。除1例出现高热外，未观察到相关不良反应。治疗期间两组患者血清甲状腺激素水平均出现轻微、无症状性升高。治疗3个月后，10例毒性结节患者中有8例出现甲亢的生化及临床缓解。两组患者促甲状腺激素（TSH）水平均显著升高（p < 0.01）。超声检查持续记录到结节体积显著缩小（p < 0.001）以及结节结构改变。对于大结节和小结节，治疗前体积与体积缩小之间均发现存在线性关系（r = 0.98；p < 0.0001），这表明即使乙醇剂量有限也可能具有治疗效果。25例患者中有16例（64%）在闪烁扫描时出现结节外实质活性恢复。这些数据证实经皮乙醇注射治疗在实现功能性消融及诱导甲亢缓解方面是有效的。不良反应较少见。尽管患者样本量较小，但每毫升组织0.5 - 1 mL乙醇剂量似乎与较大剂量一样有效，且似乎适合治疗。
