Faculdade de Medicina da Bahia (UFBA), Hospital São Rafael (HSR), Salvador, BA, Brasil,
Faculdade de Medicina da Bahia (UFBA), Salvador, BA, Brasil.
Arch Endocrinol Metab. 2021 Nov 3;65(3):322-327. doi: 10.20945/2359-3997000000363. Epub 2021 Apr 29.
Percutaneous ethanol injection (PEI) is an alternative to surgery for the treatment of thyroid nodules (TNs). However, size reductions of treated (TTNs) and untreated TN (UTNs) have not been compared. Volumetric reductions in TTNs with PEI were evaluated by comparing TTNs and UTNs in the same patient, and independent variables predicting good post-PEI outcomes were analyzed.
Overall, 282 patients with multinodular goiters were selected. Two nodules located in different lobes were compared for common disease behaviors. Overall, 150 nodules were selected from 75 patients (6 M: 69 F) with a mean age of 50.1 ± 17.4 years. This prospective nonrandomized intervention study prioritized treating TNs of greater volume or single hyperfunctioning TNs. A single observer experienced in PEI and an ultrasound specialist performed the interventions.
TTNs (mean volume: 14.8 ± 16.2 mL) were reduced by 72.6 ± 27.3% of their initial volume, while UTNs increased by a mean of 365.7 ± 1.403.8% (p < 0.00001). The patients underwent a mean of 4.0 ± 3.1 outpatient PEI sessions without relevant complications. Logistic regression analysis showed that the magnitude of the PEI induced reduction was associated with the number of treatment sessions (p = 0.03, CI [1.1-38.2]) and not with ultrasonographic characteristics of the nodules. Each PEI session increased the rate of TN reduction by a factor of 6.7.
PEI is a well-tolerated outpatient procedure that effectively reduces the volume of TNs and is noticeably superior to conservative treatment for all ultrasonographic classifications.
经皮乙醇注射（PEI）是治疗甲状腺结节（TN）的手术替代方法。然而，治疗后的结节（TTN）和未治疗的 TN（UTN）的大小减少尚未进行比较。通过比较同一患者的 TTN 和 UTN，评估了 PEI 治疗 TTN 的体积减少，并分析了预测 PEI 后良好结局的独立变量。
总共选择了 282 例多结节性甲状腺肿患者。比较了位于不同叶的两个结节以评估其共同的疾病行为。总共从 75 例（6 例男性：69 例女性）患者中选择了 150 个结节，这些患者的平均年龄为 50.1 ± 17.4 岁。这项前瞻性非随机干预研究优先治疗体积较大的 TN 或单发功能亢进的 TN。一位有经验的 PEI 单名观察者和一位超声专家进行了干预。
TTN（平均体积：14.8 ± 16.2 mL）的初始体积减少了 72.6 ± 27.3%，而 UTN 的平均增加了 365.7 ± 1.403.8%（p < 0.00001）。患者平均接受了 4.0 ± 3.1 次门诊 PEI 治疗，没有出现相关并发症。逻辑回归分析显示，PEI 诱导的减少幅度与治疗次数有关（p = 0.03，CI [1.1-38.2]），而与结节的超声特征无关。每次 PEI 治疗可使 TN 减少的速度提高 6.7 倍。
PEI 是一种耐受良好的门诊程序，可有效降低 TN 的体积，并且在所有超声分类中明显优于保守治疗。
