Wei Ying, Peng Cheng-Zhong, Wang Shu-Rong, He Jun-Feng, Peng Li-Li, Zhao Zhen-Long, Cao Xiao-Jing, Li Yan, Yu Ming-An
Department of Interventional Medicine, China-Japan Friendship Hospital, Chao-yang district, Beijing 100029, China.
Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou 310014, China.
J Clin Endocrinol Metab. 2021 Aug 18;106(9):2707-2717. doi: 10.1210/clinem/dgab240.
Ultrasound (US)-guided thermal ablation has generated recent interest as minimally invasive treatments of primary hyperparathyroidism (pHPT). But definitive evidence for the efficacy of thermal ablation in treating pHPT is not well characterized.
This work aims to evaluate the effectiveness and safety of thermal ablation for pHPT.
From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1 months (interquartile range, 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed.
A total of 119 patients (mean age, 57.2 ± 16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ± 0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except for cases with pHPT nodules less than 0.6 cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA groups (MWA vs RFA, 90.6% vs 87.0%; χ 2 = 0.275, P = .699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). With the exception of one patient with persistent voice impairment, other symptoms spontaneously resolved within 6 months.
Thermal ablation is effective and safe for pHPT.
超声（US）引导下的热消融作为原发性甲状旁腺功能亢进症（pHPT）的微创治疗方法，近来受到关注。但热消融治疗pHPT疗效的确切证据尚不明确。
本研究旨在评估热消融治疗pHPT的有效性和安全性。
回顾性分析2015年1月至2020年3月期间在4个中心接受热消融治疗pHPT患者的数据。中位随访时间为18.1个月（四分位间距为6.5 - 42.2个月）。治愈定义为在整个随访期内，至少超过6个月血清钙和完整甲状旁腺激素恢复正常。分析治疗的技术成功率、有效性和安全性。
共纳入119例患者（平均年龄57.2 ± 16.3岁；女性81例），有134个甲状旁腺结节。甲状旁腺的平均最大直径为1.6 ± 0.9 cm。96例患者接受微波消融（MWA），23例患者接受射频消融（RFA）。技术成功率为98.3%，治愈率为89.9%。治愈患者与未对靶病变进行消融的患者在最大直径上存在显著差异。除直径小于0.6 cm的pHPT结节病例外，治愈率为95%。MWA组和RFA组在6个月时的治愈率无差异（MWA组与RFA组，90.6%对87.0%；χ² = 0.275，P = 0.699）。消融区在12个月时的体积缩小率为94.6%。并发症发生率为6.7%（8/119）。除1例患者持续性声音障碍外，其他症状在6个月内自行缓解。
热消融治疗pHPT有效且安全。
