Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China.
J Otolaryngol Head Neck Surg. 2022 Jun 11;51(1):26. doi: 10.1186/s40463-022-00578-6.
For unilateral papillary thyroid carcinoma (PTC) patients with contralateral benign nodules, optimal treatment decisions are made according to patient preference and the disease's pathological features. This study was performed to evaluate the efficacy and complications of hemithyroidectomy with intraoperative radiofrequency ablation (RFA) compared with total thyroidectomy.
Patients with unilateral PTC and cytologically benign contralateral nodules were enrolled from 2014 to 2018. Total thyroidectomy or hemithyroidectomy with intraoperative RFA of the contralateral nodule was offered to patients who had anxiety regarding their disease. The operation-related parameters, transient or permanent nerve injury, hypocalcemia and disease recurrence, were recorded and compared between the two groups.
After propensity score matching, 191 patients who underwent total thyroidectomy and 224 contralateral nodules in 191 patients underwent hemithyroidectomy with intraoperative RFA (HTRFA) were included. The volume reduction ratios of the contralateral nodules were 67.7% at 12 months and 95.8% at 24 months. The total thyroidectomy group reported significantly higher hypocalcemia than HTRFA within one year (7.8% vs. 2.6%, p = 0.022). Supplemental levothyroxine was not required in 28.3% (54/191) of the patients one year after HTRFA. With a median follow-up of 4.1 years, three recurrences (1.6%) were observed in the HTRFA, and no recurrence occurred in the total thyroidectomy group (p = 0.246).
Hemithyroidectomy for unilateral PTC and intraoperative RFA for contralateral nodules were acceptable and effective treatment approaches and did not increase the risk of complications.
对于单侧甲状腺乳头状癌（PTC）合并对侧良性结节的患者，根据患者的意愿和疾病的病理特征来做出最佳的治疗决策。本研究旨在评估单侧甲状腺腺叶切除术联合术中射频消融术（RFA）与甲状腺全切除术相比的疗效和并发症。
从 2014 年至 2018 年，我们招募了单侧 PTC 合并细胞学良性对侧结节的患者。对于对疾病有焦虑的患者，我们提供甲状腺全切除术或对侧结节行术中 RFA 的甲状腺腺叶切除术。记录并比较两组之间的手术相关参数、暂时性或永久性神经损伤、低钙血症和疾病复发情况。
在进行倾向评分匹配后，191 例接受甲状腺全切除术的患者和 191 例患者中的 224 个对侧结节接受了甲状腺腺叶切除术联合术中 RFA（HTRFA）。对侧结节的体积缩小率在 12 个月时为 67.7%，在 24 个月时为 95.8%。甲状腺全切除术组在一年内发生低钙血症的比例明显高于 HTRFA 组（7.8%比 2.6%，p=0.022）。HTRFA 组中 28.3%（54/191）的患者在术后一年无需补充甲状腺素。在中位随访 4.1 年后，HTRFA 组有 3 例（1.6%）复发，甲状腺全切除术组无复发（p=0.246）。
单侧 PTC 甲状腺腺叶切除术联合对侧结节术中 RFA 是一种可接受且有效的治疗方法，不会增加并发症的风险。
