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超声引导下射频消融治疗甲状腺微小乳头状癌的疗效分析及影响因素。

Analysis of Therapeutic Effect and Influencing Factors of Ultrasound-Guided Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma.

机构信息

Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China.

Department of Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China.

出版信息

J Ultrasound Med. 2023 Aug;42(8):1769-1777. doi: 10.1002/jum.16197. Epub 2023 Mar 7.

Abstract

OBJECTIVES

The current study sought to explore the effects of ultrasound (US)-guided radiofrequency ablation (RFA) on papillary thyroid microcarcinoma (PTMC) and influencing factors.

METHODS

PTMC patients were assigned to observation (US-guided RFA) and control (surgical operation) groups. A series of operation-related indexes (operation time, intraoperative bleeding, wound closure time, hospital stay, and expenses), visual analogue scale score, lesion size, and thyroid function-related indexes (thyroid-stimulating hormone [TSH], free triiodothyronine*** [FT3], free thyroxine [FT4]), inflammatory factors, and thyroglobulin antibody (TgAb) were assessed and compared. After a 6-month follow-up period, the complications and recurrence were recorded, in addition to analyses of postoperative recurrence cumulative incidence and evaluation of recurrence risk factors.

RESULTS

Operation-related indexes of the observation group were relatively decreased compared with the control group. In addition, the lesion volume in the observation group was lower compared to that in the control group at the 6th month after operation, whereas the volume reduction rate was higher. There were no significant differences in regard to thyroid function-related indexes in the observation group before/after operation. After operation, serum TSH levels and inflammatory factors, and TgAb levels were all diminished, while the FT3 and FT4 levels were both elevated in the observation group relative to the control group, and postoperative recurrence cumulative incidence was lower in the observation group. TSH and TgAb were established as the independent risk factors for recurrence after RFA in PTMC patients.

CONCLUSIONS

Our findings highlighted that US-guided RFA exhibits better efficacy, safety, and postoperative recovery and lower recurrence risk for PTMC.

摘要

目的

本研究旨在探讨超声引导下射频消融术(RFA)治疗甲状腺微小乳头状癌(PTMC)的效果及其影响因素。

方法

将 PTMC 患者分为观察组(超声引导下 RFA)和对照组(手术治疗)。比较两组患者的围手术期相关指标(手术时间、术中出血量、切口愈合时间、住院时间和费用)、视觉模拟评分(VAS)、病灶大小、甲状腺功能相关指标(促甲状腺激素[TSH]、游离三碘甲状腺原氨酸***[FT3]、游离甲状腺素[FT4])、炎症因子和甲状腺球蛋白抗体(TgAb)。随访 6 个月,记录并发症和复发情况,分析术后复发累积发生率,并评估复发的危险因素。

结果

观察组的围手术期相关指标明显低于对照组。术后 6 个月,观察组的病灶体积明显小于对照组,体积缩小率明显高于对照组。观察组手术前后甲状腺功能相关指标差异无统计学意义。术后观察组血清 TSH 水平及炎症因子、TgAb 水平降低,FT3、FT4 水平升高,观察组术后复发累积发生率明显低于对照组。TSH 和 TgAb 是影响 RFA 治疗后 PTMC 患者复发的独立危险因素。

结论

超声引导下 RFA 治疗 PTMC 具有更好的疗效、安全性和术后恢复效果,复发风险较低。

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