Guglielmi Rinaldo, Pacella Claudio Maurizio, Bianchini Antonio, Bizzarri Giancarlo, Rinaldi Roberta, Graziano Filomena Maria, Petrucci Lucilla, Toscano Vincenzo, Palma Enzo, Poggi Maurizio, Papini Enrico
Department of Endocrine, Metabolic Digestive Diseases, Ospedale Region Apostolorum, Albano, Rome, Italy.
Thyroid. 2004 Feb;14(2):125-31. doi: 10.1089/105072504322880364.
To establish the role of percutaneous ethanol injection (PEI) treatment in benign thyroid lesions by evaluating: (1) the long-term efficacy and side effects of the treatment, (2) the factors predictive of efficacy of PEI, and (3) the cost effectiveness of the procedure.
Fifty-eight recurrent cystic nodules, 95 autonomously functioning nodules (AFTN), and 17 hyperfunctioning nodules causing thyrotoxicosis (toxic nodules) were treated by PEI from 1990 to 1996 in our center. Ultrasound (US) and color flow doppler (CFD) examinations were carried out before and after each treatment. In patients with AFTN, serum thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb) levels were tested before and after PEI. All patients were independently reexamined by two external reviewers after a minimum follow-up of 5 years (median, 6.9 years).
The median number of treatments was 2.0 (range, 1.0-4.0) for cystic nodules, 4 (range, 2.0-6.0) for AFTN, and 5 (range, 3.0-7.0) for toxic nodules. At the 5-year evaluation cystic nodules showed a volume reduction greater than 75% versus baseline in 86.2% of cases and an improvement of local symptoms in 91.4% of cases. AFTN presented serum TSH within normal limits in 60.0% of patients. Toxic nodules showed a detectable serum TSH and normal FT3 and FT4 values in 35.3% of cases. Two cases of transient dysphonia were observed. In cystic lesions no significant correlation was found between the baseline and the final volume (r2 = 0.17) and no significant predictor of treatment efficacy was found. However, unilocularity was associated with a lower number of treatments than multilocularity (median, 2.0 vs. 3.0). Independent predictors of clinical efficacy in both AFTN and toxic nodules were a baseline volume less than 5.0 mL and a fluid component greater than 30% (odds ratio [OR] = 6.1 and 3.3, respectively).
Most recurrent cystic lesions of the thyroid can be cured by PEI, which should become the first line of treatment. The majority of AFTN and toxic nodules with volume less than 5.0 mL presented a marked volume decrease and normal serum TSH levels when treated by PEI, which seems a valid alternative to clinical follow-up alone in patients refusing 131I. PEI is not indicated in large or toxic nodules, for which 131I is the treatment of choice.
通过评估以下方面来确定经皮乙醇注射（PEI）治疗在良性甲状腺病变中的作用：（1）治疗的长期疗效和副作用；（2）PEI疗效的预测因素；（3）该治疗方法的成本效益。
1990年至1996年，我们中心对58个复发性囊性结节、95个自主功能性结节（AFTN）和17个引起甲状腺毒症的功能亢进结节（毒性结节）进行了PEI治疗。每次治疗前后均进行超声（US）和彩色多普勒血流（CFD）检查。对于AFTN患者，在PEI治疗前后检测血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）水平。所有患者在至少随访5年（中位数为6.9年）后由两名外部评审员进行独立复查。
囊性结节治疗次数的中位数为2.0（范围为1.0 - 4.0），AFTN为4（范围为2.0 - 6.0），毒性结节为5（范围为3.0 - 7.0）。在5年评估时，86.2%的囊性结节病例体积较基线减少超过75%，91.4%的病例局部症状改善。60.0%的AFTN患者血清TSH在正常范围内。35.3%的毒性结节病例血清TSH可检测到且FT3和FT4值正常。观察到2例短暂性发音困难。在囊性病变中，基线体积与最终体积之间未发现显著相关性（r2 = 0.17），也未发现治疗疗效的显著预测因素。然而，单房性与多房性相比，治疗次数较少（中位数分别为2.0和3.0）。AFTN和毒性结节临床疗效的独立预测因素是基线体积小于5.0 mL且液体成分大于30%（优势比[OR]分别为6.1和3.3）。
大多数甲状腺复发性囊性病变可通过PEI治愈，PEI应成为一线治疗方法。大多数体积小于5.0 mL的AFTN和毒性结节在接受PEI治疗后体积显著减小且血清TSH水平正常，对于拒绝131I治疗的患者，这似乎是替代单纯临床随访的有效方法。对于大的或毒性结节，不建议使用PEI，131I是其首选治疗方法。
