Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.
Endocrinol Metab (Seoul). 2021 Feb;36(1):81-95. doi: 10.3803/EnM.2020.833. Epub 2021 Feb 24.
Ultrasound-guided minimally invasive procedures are widely used to treat thyroid diseases. The objective of this study was to assess the efficacy and safety of ethanol ablation (EA) in comparison with other non-surgical options in the treatment of benign thyroid cystic nodules.
We conducted a systematic search of studies on EA for thyroid cystic nodules, mainly in the Ovid-MEDLINE and Embase, Web of Science, and Cochrane databases. The standardized mean difference (SMD) of the volume reduction ratio (VRR) after EA versus other non-surgical treatments comprised the primary outcome, whereas the odds ratio (OR) of therapeutic success rates between the two groups comprised the secondary outcome.
The meta-analysis included 19 studies (four randomized controlled trials and 15 non-randomized studies) with 1,514 participants. The cumulative VRR of EA was 83.908% (95% confidence interval [CI], 79.358% to 88.457%). EA had a significantly higher pooled VRR (SMD, 0.381; 95% CI, 0.028 to 0.734; P=0.030), but not a significantly higher pooled therapeutic success rate (OR, 0.867; 95% CI, 0.132 to 5.689; P=0.880), than other forms of non-surgical management including radiofrequency ablation (RFA), polidocanol sclerotherapy, and simple aspiration with or without saline flush. However, the VRR and therapeutic success rate were not significantly different between EA and RFA. Major complications were recorded only in six patients (0.53%) with self-limiting dysphonia.
The role of EA as the first-line treatment for benign thyroid cysts and predominantly cystic nodules is supported by its high effectiveness and good safety profile compared to other currently available non-surgical options.
超声引导下的微创介入治疗在甲状腺疾病的治疗中应用广泛。本研究旨在评估与其他非手术治疗方法相比，乙醇消融术（EA）治疗甲状腺良性囊性结节的疗效和安全性。
我们对有关甲状腺囊性结节 EA 治疗的研究进行了系统检索，主要检索了 Ovid-MEDLINE、Embase、Web of Science 和 Cochrane 数据库。EA 与其他非手术治疗方法相比的体积缩小率（VRR）标准化均数差（SMD）为主要结局，两组间治疗成功率的比值比（OR）为次要结局。
该 meta 分析纳入了 19 项研究（4 项随机对照试验和 15 项非随机研究），共纳入 1514 名参与者。EA 的累积 VRR 为 83.908%（95%置信区间 [CI]，79.358%至 88.457%）。EA 的 VRR 明显更高（SMD，0.381；95%CI，0.028 至 0.734；P=0.030），但治疗成功率的 pooled OR 无显著差异（OR，0.867；95%CI，0.132 至 5.689；P=0.880），高于其他非手术治疗方法，包括射频消融术（RFA）、聚桂醇硬化疗法和单纯抽吸加或不加生理盐水冲洗。然而，EA 与 RFA 之间的 VRR 和治疗成功率无显著差异。仅在 6 名患者（0.53%）中记录到主要并发症，表现为自限性发音困难。
与其他现有非手术治疗方法相比，EA 治疗甲状腺良性囊肿和主要为囊性结节的疗效高、安全性好，支持其作为一线治疗方法的地位。
