Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan City, Fujian 364000; China.
Physical Examination Center, Longyan First Affiliated Hospital of Fujian Medical University, Longyan City, Fujian 364000, China.
Am J Otolaryngol. 2024 Jul-Aug;45(4):104259. doi: 10.1016/j.amjoto.2024.104259. Epub 2024 Mar 18.
To assess the influence of varying retention doses of ultrasound-guided polidocanol chemical ablation for benign cystic-solid thyroid nodules.
A retrospective study was conducted from December 2019 to January 2022, including 78 patients with benign cystic-solid thyroid nodules, of which 31 received polidocanol chemical ablation alone, 23 received polidocanol chemical plus thermal ablation, and 24 received open surgery. Patients who received polidocanol chemical ablation were assigned into groups based on the retention dose of polidocanol: 0 %, 10 %, 20 %, 30 %, and 50 %. Follow-ups were done at 1, 3, 6, and 12 months postoperatively. The volume of the nodules, postoperative complications, and recurrence of the nodules were examined before treatment and during follow-up visits.
Total operation time and intraoperative bleeding volume for patients who received ablation were substantially lower than those for patients who received open surgery (P < 0.001). Among patients in the polidocanol chemical ablation group, volume shrinkage rate of thyroid nodules in the 10 % retention dose group was significantly lower than that in the 0 % retention dose group at 1, 3, and 6 months postoperatively (P < 0.05). The 30 % retention dose group had the highest nodule shrinkage rate (98.46 ± 1.55 %) at 12 months postoperatively, which was significantly higher than that in the 50 % retention dose group (P < 0.05). Among patients in the polidocanol chemical and thermal ablation group, the volume shrinkage rate of thyroid nodules in the 10 % and 30 % retention dose groups at 1 month postoperatively was significantly lower than that in the 0 % retention dose group (P < 0.05). Although volume shrinkage rate in the 20 % retention dose group after thermal ablation was higher than that in the 0 % retention dose group, the difference was not statistically significant (P > 0.05). In terms of adverse reactions, the incidence of hoarseness and coughing was higher in the open surgery group than in the polidocanol chemical ablation and polidocanol chemical and thermal ablation groups, but there was no significant difference (P > 0.05).
Chemical ablation with polidocanol was safe and effective for therapy of benign cystic-solid thyroid nodules, and the optimal retention dose may be between 20 % and 30 %. Patients with poor efficacy from chemical ablation alone can receive safe and effective treatment through thermal ablation.
评估超声引导下聚多卡醇化学消融治疗良性囊实性甲状腺结节时不同保留剂量的影响。
本回顾性研究于 2019 年 12 月至 2022 年 1 月进行，纳入 78 例良性囊实性甲状腺结节患者，其中 31 例接受单纯聚多卡醇化学消融治疗，23 例接受聚多卡醇化学消融联合热消融治疗，24 例接受开放手术治疗。接受聚多卡醇化学消融治疗的患者根据聚多卡醇保留剂量分为：0%、10%、20%、30%和 50%。术后 1、3、6 和 12 个月进行随访。治疗前和随访期间检查结节体积、术后并发症和结节复发情况。
消融组患者的总手术时间和术中出血量明显低于开放手术组（P<0.001）。聚多卡醇化学消融组中，10%保留剂量组术后 1、3、6 个月的甲状腺结节体积缩小率明显低于 0%保留剂量组（P<0.05）。30%保留剂量组术后 12 个月的结节缩小率最高（98.46±1.55%），明显高于 50%保留剂量组（P<0.05）。聚多卡醇化学和热消融组中，10%和 30%保留剂量组术后 1 个月的甲状腺结节体积缩小率明显低于 0%保留剂量组（P<0.05）。虽然热消融后 20%保留剂量组的体积缩小率高于 0%保留剂量组，但差异无统计学意义（P>0.05）。在不良反应方面，开放手术组的声音嘶哑和咳嗽发生率高于聚多卡醇化学消融组和聚多卡醇化学和热消融组，但差异无统计学意义（P>0.05）。
聚多卡醇化学消融治疗良性囊实性甲状腺结节安全有效，最佳保留剂量可能在 20%~30%之间。单独化学消融效果不佳的患者可通过热消融获得安全有效的治疗。
