Zingrillo M, Torlontano M, Ghiggi M R, D'Aloiso L, Nirchio V, Bisceglia M, Liuzzi A
Division of Endocrinology, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, Italy.
Thyroid. 1996 Oct;6(5):403-8. doi: 10.1089/thy.1996.6.403.
To evaluate the effect of percutaneous ethanol injection (PEI) in the treatment of large compressive thyroid cystic nodules (TCN), we studied 20 patients, potential candidates for surgery (tracheal displacement, nodule volume over 10 mL at ultrasonography) and not cured by aspiration alone: 14 experienced a recurrence after two complete evacuations of cystic fluid (watery nodules, WN); in six an aspiration was impossible because the cystic fluid was very thick (viscous nodules, VN). To exclude malignancy, both cytocentrifugate from WN and the smears from VN were examined. WN were treated with 1-4 sessions of conventional PEI; in VN a first PEI session was performed with the purpose of reducing the density of cystic fluid; then if cystic fluid was successfully aspirated, one or more PEI sessions were performed. Thyroid palpation, ultrasonography with nodule volume assessment, and assays for FT3, FT4, and TSH were performed 1 and 6 months after the last PEI. At month 6, 17 patients (85%) had volume reduction of more than 90% of the initial nodule volume; in 2 patients (10%) there was a reduction between 50 and 90%, and in one patient (5%) an appreciable swelling persisted after 3 injections. Nodule volume was significantly decreased below baseline at month 1 (10.9 +/- 13.3 vs 39 +/- 24 mL, p < 0.001), with a further reduction at month 6 (5 +/- 11.7 mL, p < 0.01 vs 1st month value). In most of the nodules the cystic portion completely disappeared; the residual tissue showed fibrous features, often with calcifications. In 11 patients follow-up was prolonged over the sixth month (15 +/- 4 months); the nodule volume did not significantly differ from the sixth month (3 +/- 2.2 mL) and the end of the follow-up (2.8 +/- 2.3 mL). In conclusion, we demonstrate that PEI may be a safe and effective procedure in the treatment of large TCN.
为评估经皮乙醇注射（PEI）治疗大型压迫性甲状腺囊性结节（TCN）的效果，我们研究了20例患者，这些患者均为手术潜在候选者（存在气管移位，超声检查结节体积超过10 mL）且单纯穿刺抽吸无法治愈：14例在两次完全抽吸出囊液后复发（水样结节，WN）；6例因囊液非常浓稠无法进行抽吸（粘性结节，VN）。为排除恶性病变，对WN的细胞离心沉淀物和VN的涂片均进行了检查。WN接受1 - 4次常规PEI治疗；VN先进行首次PEI治疗以降低囊液密度；若成功抽吸出囊液，则再进行一次或多次PEI治疗。在最后一次PEI治疗后的1个月和6个月进行甲状腺触诊、评估结节体积的超声检查以及FT3、FT4和TSH检测。在第6个月时，17例患者（85%）结节体积减少超过初始结节体积的90%；2例患者（10%）减少了50%至90%，1例患者（5%）在3次注射后仍有明显肿胀。在第1个月时，结节体积显著低于基线水平（10.9±13.3 vs 39±24 mL，p<0.001），在第6个月时进一步减小（5±11.7 mL，与第1个月的值相比p<0.01）。在大多数结节中，囊性部分完全消失；残留组织呈现纤维特征，常伴有钙化。11例患者的随访延长至第6个月以后（15±4个月）；结节体积与第6个月（3±2.2 mL）和随访结束时（2.8±2.3 mL）相比无显著差异。总之，我们证明PEI可能是治疗大型TCN的一种安全有效的方法。
