Jeong So Yeong, Cho Se Jin, Baek Jung Hwan
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2025 Jun 7. doi: 10.1007/s00330-025-11739-2.
OBJECTIVES: Minimally invasive treatments such as ethanol ablation (EA), microwave ablation (MWA), and radiofrequency ablation (RFA) are options for parathyroid lesion treatment, especially in patients ineligible for or declining surgery. We aimed to assess the safety of minimally invasive treatments for parathyroid lesions. MATERIALS AND METHODS: PubMed and Embase were searched for original literature published on or before September 27, 2023, and 34 studies with 2102 patients (12 EA, 1 laser ablation, 10 MWA, 10 RFA, 1 both EA and RFA) were included. The pooled incidence of complications associated with chemical or thermal ablation was calculated. Subgroup analyses were performed according to ablation method and type of hyperparathyroidism (primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT)). RESULTS: The overall pooled incidences of total, major, and minor complications were 19.1%, 5%, and 12.7%, respectively. Among complications, incidences of permanent and transient voice change were 2.7% and 8.9%, respectively. In subgroup analysis, the incidence of major complications was significantly higher in MWA than in EA or RFA (p = 0.032), whereas total and minor complications were higher in MWA than others, but there was no statistical significance. The pooled incidence of major complications was significantly higher in SHPT than in PHPT (1.9% vs.11.0%, p = 0.024). CONCLUSIONS: The overall incidences of total, major, and minor complications were 19.1%, 5%, and 12.7%, respectively. Patients treated with MWA had a significantly higher incidence of major complications than patients treated with other methods. Patients with SHPT had a significantly higher incidence of major complications compared with patients with PHPT. KEY POINTS: Question What are the safety outcomes of minimally invasive treatments, including chemical or thermal ablation, for patients with parathyroid lesions? Findings Overall incidences of total, major, and minor complications were 19.1%, 5%, and 12.7%, and of permanent and transient voice change were 2.7% and 8.9%. Clinical relevance Microwave ablation demonstrated significantly higher major complication rates than other chemical or thermal ablation methods. Patients with secondary hyperparathyroidism showed significantly higher major complication rates than patients with primary hyperparathyroidism.
目的：乙醇消融（EA）、微波消融（MWA）和射频消融（RFA）等微创治疗是甲状旁腺病变的治疗选择，尤其是对于不适合手术或拒绝手术的患者。我们旨在评估甲状旁腺病变微创治疗的安全性。 材料与方法：检索PubMed和Embase上截至2023年9月27日发表的原始文献，纳入34项研究共2102例患者（12例EA、1例激光消融、10例MWA、10例RFA、1例EA和RFA联合治疗）。计算化学或热消融相关并发症的合并发生率。根据消融方法和甲状旁腺功能亢进类型（原发性甲状旁腺功能亢进（PHPT）和继发性甲状旁腺功能亢进（SHPT））进行亚组分析。 结果：总体并发症、主要并发症和次要并发症的合并发生率分别为19.1%、5%和12.7%。并发症中，永久性和暂时性声音改变的发生率分别为2.7%和8.9%。亚组分析中，MWA的主要并发症发生率显著高于EA或RFA（p = 0.032），而MWA的总体和次要并发症高于其他方法，但无统计学意义。SHPT的主要并发症合并发生率显著高于PHPT（1.9%对11.0%，p = 0.024）。 结论：总体并发症、主要并发症和次要并发症的发生率分别为19.1%、5%和12.7%。接受MWA治疗的患者主要并发症发生率显著高于接受其他方法治疗的患者。与PHPT患者相比，SHPT患者的主要并发症发生率显著更高。 关键点：问题 对于甲状旁腺病变患者，包括化学或热消融在内的微创治疗的安全性结果如何？ 发现 总体并发症、主要并发症和次要并发症的发生率分别为19.1%、5%和12.7%，永久性和暂时性声音改变的发生率分别为2.7%和8.9%。 临床意义 微波消融显示主要并发症发生率显著高于其他化学或热消融方法。继发性甲状旁腺功能亢进患者的主要并发症发生率显著高于原发性甲状旁腺功能亢进患者。
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