Department of Oto-Rhino-Laryngology and Neck Surgery, Odense University Hospital, DK-5000 Odense C, Denmark.
Eur J Endocrinol. 2011 Jul;165(1):123-8. doi: 10.1530/EJE-11-0220. Epub 2011 May 6.
To evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules.
A total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5-3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic complaints were evaluated on a visual analogue scale (0-10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12-114).
The overall median nodule volume decreased from 8.2 ml (range 2.0-25.9) to 4.1 ml (range 0.6-33.0; P<0.001) at the final evaluation, corresponding to a median reduction of 51% (range: -194 to 95%). This correlated with a significant decrease in pressure as well as cosmetic complaints. After 12--96 months (median 38 months) of ILP, 21 patients (29%) had thyroid surgery because of an unsatisfactory result. All had benign histology. Thyroid function was unaltered throughout and side effects were restricted to mild local pain.
US-guided ILP results in a satisfactory long-term clinical response in the majority of patients with a benign solitary solid cold thyroid nodule. Further large-scale studies should aim at optimizing selection criteria for ILP, preferably in randomized studies.
评估间质激光光凝术（ILP）治疗单发良性甲状腺结节的长期疗效。
共有 78 例甲状腺功能正常的门诊患者（45 例参与随机试验）纳入本研究，这些患者均患有单发实性冷结节的良性甲状腺肿，并伴有局部不适。在超声（US）引导下，使用一根激光光纤，以 1.5-3.5W 的输出功率进行 ILP。在治疗前和随访期间，通过 US 评估甲状腺结节体积，通过常规检测评估甲状腺功能。采用视觉模拟评分（0-10cm）评估压迫症状和美容投诉。总共有 6 例患者在 ILP 后 6 个月行甲状腺手术，3 例患者失访。69 例患者的中位随访时间为 67 个月（范围 12-114 个月）。
总的来说，结节体积中位数从 8.2ml（范围 2.0-25.9）下降至治疗结束时的 4.1ml（范围 0.6-33.0；P<0.001），中位数下降 51%（范围：-194 至 95%）。这与压迫症状和美容投诉的显著改善相关。ILP 后 12-96 个月（中位时间 38 个月），21 例（29%）患者因疗效不满意行甲状腺手术，所有患者均为良性组织学。整个过程中甲状腺功能未改变，不良反应仅限于轻度局部疼痛。
在大多数患有单发实性冷结节的良性甲状腺肿患者中，US 引导的 ILP 可获得令人满意的长期临床疗效。应进一步开展大规模研究，旨在优化 ILP 的选择标准，最好在随机研究中进行。
