良性甲状腺结节的治疗：手术与射频消融的比较
Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation.
作者信息
Che Y, Jin S, Shi C, Wang L, Zhang X, Li Y, Baek J H
机构信息
From the Departments of Ultrasound (Y.C., L.W., X.Z.)
Laparoscopic Surgery (S.J.).
出版信息
AJNR Am J Neuroradiol. 2015 Jul;36(7):1321-5. doi: 10.3174/ajnr.A4276. Epub 2015 Mar 26.
BACKGROUND AND PURPOSE
Nodular goiter is one of the most common benign lesions in thyroid nodule. The main treatment of the disease is still the traditional surgical resection, however there are many problems such as general anesthesia, surgical scar, postoperative thyroid or parathyroid function abnormalities, and high nodules recurrence rate in residual gland. The purpose of this study was to compare the efficacy, safety, and cost-effectiveness of 2 treatment methods, surgery and radiofrequency ablation, for the treatment of benign thyroid nodules.
MATERIALS AND METHODS
From May 2012 to September 2013, 200 patients with nodular goiters who underwent surgery (group A) and 200 patients treated by radiofrequency ablation (group B) were enrolled in this study. Inclusion criteria were the following: 1) cosmetic problem, 2) nodule-related symptoms, 3) hyperfunctioning nodules related to thyrotoxicosis, and 4) refusal of surgery (for group B). An internally cooled radiofrequency ablation system and an 18-ga internally cooled electrode were used. We compared the 2 groups in terms of efficacy, safety, and cost-effectiveness during a 1-year follow-up.
RESULTS
After radiofrequency ablation, the nodule volume decreased significantly from 5.4 to 0.4 mL (P = .002) at the 12-month follow-up. The incidence of complications was significantly higher from surgery than from radiofrequency ablation (6.0% versus 1.0%, P = .002). Hypothyroidism was detected in 71.5% of patients after surgery but in none following radiofrequency ablation. The rate of residual nodules (11.9% versus 2.9%, P = .004) and hospitalization days was significantly greater after surgery (6.6 versus 2.1 days, P < .001), but the cost difference was not significant.
CONCLUSIONS
Surgical resection and radiofrequency ablation are both effective treatments of nodular goiter. Compared with surgery, the advantages of radiofrequency ablation include fewer complications, preservation of thyroid function, and fewer hospitalization days. Therefore, radiofrequency ablation should be considered a first-line treatment for benign thyroid nodules.
背景与目的
结节性甲状腺肿是甲状腺结节中最常见的良性病变之一。该病的主要治疗方法仍是传统的手术切除，但存在诸多问题，如全身麻醉、手术疤痕、术后甲状腺或甲状旁腺功能异常以及残余腺体中结节复发率高等。本研究的目的是比较手术和射频消融这两种治疗方法治疗良性甲状腺结节的疗效、安全性和成本效益。
材料与方法
2012年5月至2013年9月，本研究纳入了200例行手术治疗的结节性甲状腺肿患者（A组）和200例接受射频消融治疗的患者（B组）。纳入标准如下：1）美观问题；2）结节相关症状；3）与甲状腺毒症相关的功能亢进结节；4）拒绝手术（适用于B组）。使用了一种内部冷却的射频消融系统和一根18号内部冷却电极。我们在1年的随访期间比较了两组在疗效、安全性和成本效益方面的情况。
结果
射频消融后，在12个月随访时结节体积从5.4 mL显著减小至0.4 mL（P = 0.002）。手术并发症的发生率显著高于射频消融（6.0%对1.0%，P = 0.002）。术后71.5%的患者检测到甲状腺功能减退，但射频消融后无一例出现。手术后排留结节的发生率（11.9%对2.9%，P = 0.004）和住院天数显著更高（6.6天对2.1天，P < 0.001），但成本差异不显著。
结论
手术切除和射频消融都是治疗结节性甲状腺肿的有效方法。与手术相比，射频消融的优点包括并发症更少、甲状腺功能得以保留以及住院天数更少。因此，射频消融应被视为良性甲状腺结节的一线治疗方法。
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