Department of Graduate, Bengbu Medical College, Bengbu, China.
Department of Ultrasound, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Korean J Radiol. 2022 May;23(5):555-565. doi: 10.3348/kjr.2021.0716.
To assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT).
This prospective study enrolled 39 participants (14 male, 25 female; mean age, 59.5 ± 15.3 [range, 18-87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation.
Complete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 ± 4.6 (range, 6.0-24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1-3 months.
US-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.
评估超声引导下射频消融（RFA）治疗原发性甲状旁腺功能亢进症（PHPT）的疗效和安全性。
本前瞻性研究纳入了 2018 年 9 月 1 日至 2021 年 1 月 31 日期间的 39 名参与者（14 名男性，25 名女性；平均年龄 59.5±15.3[18-87]岁）。所有参与者均有甲状旁腺病变引起的 PHPT，通过生化和影像学检查证实。在治疗前评估 PHPT 结节的影像学特征，包括形状、边缘、大小、成分和位置。治疗前后记录血清全段甲状旁腺激素、钙和磷水平、甲状旁腺结节体积以及与 PHPT 相关的症状。我们计算了这些患者的技术成功率、生化治愈率和临床治愈率。评估了消融过程中和消融后的并发症。
39 名参与者的 39 个结节中，有 38 个完全消融。所有患者均在一次治疗中接受治疗。技术成功率为 97.4%（38/39）。平均随访时间为 13.2±4.6（6.0-24.9）个月。在 RFA 后 6 个月和 12 个月时，生化治愈率分别为 82.1%（32/39）和 84.4%（27/32），临床治愈率分别为 100%（39/39）和 96.9%（31/32）。只有 2.6%（1/39）的患者出现复发性 PHPT。在技术上成功的 RFA 后 1、3、6 和 12 个月，分别有 44.7%（17/38）、34.3%（12/35）、15.8%（6/38）和 12.5%（4/32）的参与者血钙正常甲状旁腺激素水平升高。喉返神经麻痹的发生率为 5.1%（2/39），患者在 1-3 个月内自发恢复。
超声引导下 RFA 治疗 PHPT 患者安全有效。RFA 可能是不能耐受或拒绝手术的患者的另一种治疗手段。
