Solymosi Tamás
Pajzsmirigy Szakrendelés,Bugát Pál KórházGyöngyös.
Orv Hetil. 2020 Feb;161(6):224-231. doi: 10.1556/650.2020.31658.
Although percutaneous ethanol sclerotherapy for the treatment of benign thyroid nodules (PEI) has been used for more than 30 years, there are only two studies in thyroid cysts (THCY) and 2 in autonomously functioning nodule (AFN) in which the mean follow-up reaches at least five years, while in the event of non-autonomously functioning solid nodules (NAS), there is not any study with at least 5-year mean follow-up. Our study focuses on the long-term efficacy of PEI in benign thyroid nodules. We analyzed the long-term success of PEI in 254 patients treated for more than 10 years. The success was defined as 50% or greater reduction in nodule volume. In addition, the patient had to remain euthyroid without thyrostatic therapy in AFN. The 10-year success rate was 79.4%, 37.1% and 69.4% in THCY, AFN and NAS, respectively. In 23.3% of unsuccessful PEIs, the failure could be revealed only after 5 years of follow-up. The mean nodule volume at 10-year follow-up related to the initial size was 29.8%, 39.6% and 48.9% in THCY, NAS and AFN, respectively. In THCY, PEI proved to be significantly more effective in older patients while other parameters (size of the nodule, amount of the injected alcohol and the ratio of these) did not correlate significantly with the success rate. Our study which presents the longest follow-up in all 3 types of benign thyroid nodules confirms that PEI has a minimal role in AFN, is recommendable in THCY and might have a role in NAS. The success rate decreases over time which emphasizes the importance of the long-term follow-up in the judgement of PEI. Orv Hetil. 2020; 161(6): 224-231.
尽管经皮乙醇硬化疗法（PEI）用于治疗良性甲状腺结节已有30多年，但关于甲状腺囊肿（THCY）的研究仅有两项，关于自主功能性结节（AFN）的研究有两项，且平均随访时间至少达5年；而对于非自主功能性实性结节（NAS），尚无平均随访时间至少5年的研究。我们的研究聚焦于PEI治疗良性甲状腺结节的长期疗效。我们分析了254例接受治疗超过10年的患者接受PEI治疗的长期成功率。成功的定义为结节体积缩小50%或更多。此外，AFN患者在未接受抗甲状腺药物治疗的情况下必须保持甲状腺功能正常。THCY、AFN和NAS的10年成功率分别为79.4%、37.1%和69.4%。在23.3%的PEI治疗失败病例中，只有在随访5年后才能发现失败情况。THCY、NAS和AFN在10年随访时的平均结节体积与初始大小相比分别为29.8%、39.6%和48.9%。在THCY中，PEI在老年患者中被证明明显更有效，而其他参数（结节大小、注射乙醇量及其比例）与成功率无显著相关性。我们的研究给出了所有3种类型良性甲状腺结节最长的随访时间，证实PEI在AFN中的作用极小，在THCY中值得推荐，在NAS中可能有一定作用。成功率随时间下降，这强调了长期随访在评估PEI中的重要性。《匈牙利医学周报》。2020年；161(6): 224 - 231。
