Gambelunghe Giovanni, Fede Raffaela, Bini Vittorio, Monacelli Massimo, Avenia Nicola, D'Ajello Michele, Colella Renato, Nasini Giovanni, De Feo Pierpaolo
Department of Internal Medicine, Section of Internal Medicine and Metabolic and Endocrine Diseases, University of Perugia, Perugia, Italy.
Surg Innov. 2013 Aug;20(4):345-50. doi: 10.1177/1553350612459276. Epub 2012 Sep 17.
According to cross-sectional surveys, the prevalence of nontoxic nodular goiter appears to be higher in the adult population. Surgical intervention is indicated for the following: (a) progressive goiter growth, (b) compression of organs such as the trachea and esophagus, and (c) significant aesthetic disfigurement. Ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules is a viable alternative to traditional surgery. However, studies that have appeared in literature since the introduction of ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules report contradictory data concerning the energy required for nodule ablation. The aim of the present trial was to evaluate retrospectively the efficacy of percutaneous laser thermal ablation in 2 groups of patients, one treated with low, and the other with high, total amount of energy.
Forty euthyroid patients were treated with 1 session of percutaneous laser photocoagulation treatment at low (median = 71 J/mL; 20 patients) and high (median = 578 J/mL; 20 patients) energy. The volume of the nodules was measured by the same investigator, blinded for treatment, using the ellipsoid formula before treatment, at 2, 4, 8, and 30 weeks, and every 6 months for 3 years thereafter.
Thyroid nodule ablation is effective over time only if a sufficient amount of energy (>400-500 J/mL for the nodular tissue to be treated) is given, although it incurs proportionate side effects.
Percutaneous laser thermal ablation is a viable alternative to traditional surgery for the treatment of benign nodular thyroid disease only if a sufficient amount of energy is delivered.
根据横断面调查，成人非毒性结节性甲状腺肿的患病率似乎更高。手术干预适用于以下情况：（a）甲状腺肿进行性生长，（b）气管和食管等器官受压，以及（c）明显的美观缺陷。超声引导下激光光凝治疗良性甲状腺结节是传统手术的一种可行替代方法。然而，自超声引导下激光光凝用于治疗良性甲状腺结节以来，文献中出现的研究报告了关于结节消融所需能量的相互矛盾的数据。本试验的目的是回顾性评估经皮激光热消融在两组患者中的疗效，一组采用低总能量治疗，另一组采用高总能量治疗。
40例甲状腺功能正常的患者接受了1次经皮激光光凝治疗，低能量组（中位数 = 71 J/mL；20例患者）和高能量组（中位数 = 578 J/mL；20例患者）。结节体积由同一名对治疗不知情的研究者在治疗前、治疗后2周、4周、8周和30周，以及此后3年每6个月使用椭球体公式进行测量。
甲状腺结节消融只有在给予足够能量（待治疗的结节组织>400 - 500 J/mL）时才会随时间有效，尽管会产生相应的副作用。
只有在传递足够能量的情况下，经皮激光热消融才是治疗良性结节性甲状腺疾病的传统手术的可行替代方法。
