Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil.
Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil; Department of Radiology, Hospital Israelita Albert Einstein. São Paulo, 05652-000 Brazil.
Eur J Radiol. 2020 Dec;133:109354. doi: 10.1016/j.ejrad.2020.109354. Epub 2020 Oct 16.
To describe our group experience in treatment of benign symptomatic thyroid nodules using radiofrequency ablation technique always associated to routine pre-procedure hydrodissection and under sedation with programmed stop.
Dual-center, retrospective study conducted between April 2018 and January 2020. A total of 52 symptomatic benign thyroid nodules were treated in 34 patients with ultrasound-guided percutaneous radiofrequency ablation. The technique of choice was moving-shot technique and 100 % patients underwent pre-procedural hydrodissection with 5% glucose solution, plus conscious sedation with programmed stop during procedure.
Most nodules were solid or almost completely solid (n = 45, 88.3 % of nodules), followed by cystic composition (n = 4, 7.8 %) and mixed (n = 2, 3.9 %). As for location, most were on the right lobe (n = 29, 56.9 %), followed by the left lobe (n = 17, 33.3 %) and isthmus (n = 5, 9.8 %). The average volume of nodules before ablation was 18.2 ± 20.5 mL. Volumetric reduction rates at one, three, six and twelve months after ablation were 46.6 %, 64.5 %, 76.1 % and 88.8 %, respectively. No complications strictly related to procedure were reported. No more than 5 min were added to total time of ablative treatment considering routine hydrodissection and stop programmed sedation.
Minimally invasive therapies applied to thyroid allow the preservation of healthy thyroid parenchyma and provide a very effective volumetric reduction of symptomatic benign thyroid nodules. Hydrodissection with 5 % glucose solution, conscious sedation and patient stimulation with programmed stop during procedure may provide greater safety to procedure, and, in our experience, could be done routinely in all patients.
描述我们在常规术前水分离的基础上联合镇静下程序停止，应用射频消融技术治疗有症状良性甲状腺结节的经验。
2018 年 4 月至 2020 年 1 月，进行了一项多中心、回顾性研究。对 34 例患者共 52 个有症状的良性甲状腺结节进行了超声引导下经皮射频消融治疗。选择的技术是移动射击技术，所有患者均行术前水分离（5%葡萄糖溶液），并在术中进行镇静（程序停止）。
大多数结节为实性或几乎完全实性（n=45，占结节的 88.3%），其次是囊性成分（n=4，占 7.8%）和混合性（n=2，占 3.9%）。就位置而言，大多数位于右叶（n=29，占 56.9%），其次是左叶（n=17，占 33.3%）和峡部（n=5，占 9.8%）。消融前结节的平均体积为 18.2±20.5mL。消融后 1、3、6 和 12 个月的体积缩小率分别为 46.6%、64.5%、76.1%和 88.8%。未报告与手术相关的并发症。考虑到常规水分离和程序停止镇静，消融治疗的总时间仅增加了不超过 5 分钟。
应用于甲状腺的微创治疗可以保留健康的甲状腺实质，并提供非常有效的有症状良性甲状腺结节体积缩小。5%葡萄糖溶液水分离、清醒镇静和程序停止刺激患者可能会使手术更加安全，并且根据我们的经验，所有患者都可以常规进行。
