Ha Eun Ju, Baek Jung Hwan, Kim Kyung Won, Pyo Junhee, Lee Jeong Hyun, Baek Seung Hee, Døssing Helle, Hegedüs Laszlo
Department of Radiology (E.J.H.), Ajou University School of Medicine, Suwon 443-380, Korea; Department of Radiology and Research Institute of Radiology (J.H.B., K.W.K., J.H.L.), University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea; WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science (J.P.), Utrecht University, Netherlands; Department of Clinical Epidemiology and Biostatistics (S.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea; and Departments of Otorhinolaryngology (H.D.) and Endocrinology (L.H.), Odense University Hospital, DK-5000 Odense C, Denmark.
J Clin Endocrinol Metab. 2015 May;100(5):1903-11. doi: 10.1210/jc.2014-4077. Epub 2015 Feb 19.
To compare the efficacy of radiofrequency ablation (RFA) and laser ablation (LA) for treatment of benign solid thyroid nodules, using a systematic review including traditional pooling and Bayesian network meta-analysis.
A comprehensive literature search in PubMed-MEDLINE, EMBASE, and the Cochrane Library databases identified prospective studies evaluating the percentage mean change [absolute mean change (mL)] in nodule volume after RFA or LA. Studies from January 1, 2000, to November 1, 2013, were included. Review of 128 potential papers, including a full-text review of 33, identified 10 eligible papers covering a total of 184 patients for meta-analysis. The percentage mean change [absolute mean change] in nodule volume over a 6-month follow-up was compared between RFA and LA.
Based on the traditional frequentist approach, the pooled percentage mean changes (95% confidence interval) of RFA and LA were 76.1% (70.1-82.1) and 49.9% (41.4-58.5), respectively, and the pooled absolute mean changes (95% confidence interval) of RFA and LA were 8.9 mL (6.6-11.2) and 5.2 mL (4.3-6.1), respectively. Based on the Bayesian network meta-analysis, RFA achieved a larger pooled percentage mean change (95% credible interval) and absolute mean change (95% credible interval) compared to LA [77.8% (67.7-88.0) vs 49.5% (26.7-72.4), and 9.2 mL (5.8-11.9) vs 5.3 mL (2.1-8.5), respectively]. The RFA group has the highest probability of having the most efficacious treatment (98.7%). There were no major complications after either RFA or LA.
RFA appears to be superior to LA in reducing benign solid thyroid nodule volume, despite the smaller number of treatment sessions without major side effects.
采用包括传统合并分析和贝叶斯网络Meta分析在内的系统评价，比较射频消融（RFA）和激光消融（LA）治疗良性实性甲状腺结节的疗效。
在PubMed-MEDLINE、EMBASE和Cochrane图书馆数据库中进行全面的文献检索，以确定评估RFA或LA后结节体积平均变化百分比[绝对平均变化量（mL）]的前瞻性研究。纳入2000年1月1日至2013年11月1日期间的研究。对128篇潜在论文进行综述，包括对33篇论文的全文审查，确定了10篇符合条件的论文，共184例患者纳入Meta分析。比较RFA和LA在6个月随访期间结节体积的平均变化百分比[绝对平均变化量]。
基于传统的频率学派方法，RFA和LA的合并平均变化百分比（95%置信区间）分别为76.1%（70.1-82.1）和49.9%（41.4-58.5），RFA和LA的合并绝对平均变化量（95%置信区间）分别为8.9 mL（6.6-11.2）和5.2 mL（4.3-6.1）。基于贝叶斯网络Meta分析，与LA相比，RFA的合并平均变化百分比（95%可信区间）和绝对平均变化量（95%可信区间）更大[分别为77.8%（67.7-88.0）对49.5%（26.7-72.4），以及9.2 mL（5.8-11.9）对5.3 mL（2.1-8.5）]。RFA组进行最有效治疗的概率最高（98.7%）。RFA或LA后均未出现严重并发症。
尽管RFA治疗次数较少且无严重副作用，但在缩小良性实性甲状腺结节体积方面似乎优于LA。
