Bennedbaek F N, Karstrup S, Hegedüs L
Department of Endocrinology M, Odense University Hospital, Denmark.
Eur J Endocrinol. 1997 Mar;136(3):240-50. doi: 10.1530/eje.0.1360240.
Relevant English language articles published from 1966 to 1995 regarding ethanol therapy in the treatment of thyroid and parathyroid diseases were identified through a MEDLINE search and manual searches of identified articles. The sclerosing properties of ethanol have been recognized for many years and have offered interventional possibilities in the management of various benign as well as malignant lesions. The mechanism of action of ethanol appears to be related to a direct coagulative necrosis and local partial or complete small vessel thrombosis. Ultrasound-guided percutaneous ethanol injection therapy (PEIT) is rapid and performed on an out-patient basis and has now gained wide acceptance due to the accumulating evidence of the efficacy and safety of this therapeutic tool. Yet, there is a lack of prospective, randomized clinical trials comparing PEIT with 131I therapy or surgery with regard to its effects, especially long-term ones and it should therefore still be considered an experimental procedure. In benign endocrine diseases, PEIT has shown promising results in the treatment of autonomous thyroid nodules, benign solitary cold solid as well as cystic thyroid nodules and parathyroid tumours. Its use in pretoxic and toxic thyroid nodules has been evaluated in several uncontrolled studies, all demonstrating a high success rate in spite of the large number of treatments needed. So far efficacy and cost-effectiveness seem inferior to 131I and surgery. Short-term results of PEIT in benign cystic thyroid nodules are convincing with a high cure rate, but no controlled studies with long-term results are available. Preliminary results suggest that PEIT could become an alternative to surgical excision or levothyroxine therapy in the symptomatic solid cold benign thyroid nodule. Ultrasound-guided PEIT of parathyroid tumours has proven to be a useful method in highly selected patients in whom surgery has been found non-attractive and medical treatment ineffective. However, no prospective randomized trials have been published comparing the results of PEIT in parathyroid tumours with conventional surgical and medical treatments. PEIT has never been tested against standard therapy, but seems inferior to 131I and surgery. Side-effects caused by ethanol injection are generally few and transient and are related to the injection into solid nodules rather than cysts. Ethanol injection into solid profund nodules may seriously jeopardize subsequent surgery because of perinodular fibrosis. As an experimental procedure, not yet evaluated sufficiently, it should be reserved for patients who cannot or will not undergo standard therapy. Caution in routine use is advisable.
通过医学文献数据库（MEDLINE）检索以及对已识别文章的手动检索，找出了1966年至1995年间发表的关于乙醇疗法治疗甲状腺和甲状旁腺疾病的相关英文文章。乙醇的硬化特性多年来已得到认可，并为各种良性和恶性病变的治疗提供了干预可能性。乙醇的作用机制似乎与直接的凝固性坏死以及局部部分或完全小血管血栓形成有关。超声引导下经皮乙醇注射疗法（PEIT）操作迅速，可在门诊进行，由于该治疗手段有效性和安全性的证据不断积累，现已获得广泛认可。然而，缺乏前瞻性、随机临床试验来比较PEIT与131I疗法或手术在疗效方面的差异，尤其是长期疗效，因此它仍应被视为一种试验性程序。在良性内分泌疾病中，PEIT在自主甲状腺结节、良性孤立性实性及囊性甲状腺结节以及甲状旁腺肿瘤的治疗中已显示出有前景的结果。在一些非对照研究中对其在亚临床毒性和毒性甲状腺结节中的应用进行了评估，所有研究均表明尽管需要大量治疗，但成功率很高。到目前为止，其疗效和成本效益似乎不如131I疗法和手术。PEIT治疗良性囊性甲状腺结节的短期结果令人信服，治愈率高，但尚无有长期结果的对照研究。初步结果表明，对于有症状的实性冷性良性甲状腺结节，PEIT可能成为手术切除或左甲状腺素治疗的替代方法。对于高度选择的患者，超声引导下甲状旁腺肿瘤的PEIT已被证明是一种有用的方法，这些患者被认为手术不可行且药物治疗无效。然而，尚未发表前瞻性随机试验来比较甲状旁腺肿瘤的PEIT结果与传统手术和药物治疗的结果。PEIT从未与标准疗法进行过对比测试，但似乎不如131I疗法和手术。乙醇注射引起的副作用通常很少且短暂，与注入实性结节而非囊肿有关。向实性深部结节注射乙醇可能会因结节周围纤维化而严重危及后续手术。作为一种尚未得到充分评估的试验性程序，它应仅用于无法或不愿接受标准疗法的患者。建议在常规使用时谨慎。
