Monzani F, Caraccio N, Goletti O, Casolaro A, Lippolis P V, Cavina E, Miccoli P
Department of Internal Medicine, University of Pisa, Italy.
Exp Clin Endocrinol Diabetes. 1998;106 Suppl 4:S54-8. doi: 10.1055/s-0029-1212058.
The aim of our study was to define the long-term efficacy and safety of percutaneous ethanol injection (PEI) for the treatment of autonomous thyroid nodule (ATN), and to optimise the clinical usefulness of such a therapy. We treated 132 patients with ATN (30 M and 102 F, aged 47.5+/-12.9 years; mean+/-SD), in case other established treatments were refused or contraindicated. Eighty-five patients were affected by toxic adenoma and 47 suffered from pre-toxic nodules. Ethanol was administered weekly under sonographic control, in 7 sessions (range 2-16). During PEI treatment, 26 toxic elderly patients were treated with methimazole and propranolol. Three possible outcomes were identified for statistical analysis: failure (persistent suppression of extra nodular tissue uptake, along with elevated free thyroid hormone and undetectable TSH levels); partial cure (normal free thyroid hormone and low/undetectable TSH levels); complete cure (normal thyroid hormone and TSH levels; restored extra nodular uptake). The patients were followed for up to 8.5 years (median 76 months). PEI therapy was well tolerated by all patients though a mild to moderate local pain occurred in about 30% of sessions. Complete cure was achieved in all pre-toxic patients and in 60 (70.6%) patients with toxic adenoma, while partial cure was observed in 11 cases (12.9%) and failure in 14 (16.5%). A significant shrinkage of nodule volume was observed in all patients (p = 0.0001), while those with toxic nodules larger than 30 mL showed a significantly lower response rate to PEI (p < 0.05). At controls, only one patient developed subclinical hypothyroidism while, among partially cured patients, five relapsed. The administration of methimazole and/or propranolol did not modify PEI outcome. In conclusion, we suggest that PEI therapy may be the treatment of choice in patients with pre-toxic thyroid adenoma where therapy is least necessary- despite the nodule volume. Though ethanol injection therapy of toxic thyroid nodules may be troublesome for the need of multiple sessions, it appears an effective alternative procedure in patients at poor surgical risk, and in younger patients in whom radioiodine is contraindicated. Since a special technical skill in intervention procedures is required, PEI therapy may be suitable only for patients living nearby a trained centre.
我们研究的目的是确定经皮乙醇注射（PEI）治疗自主性甲状腺结节（ATN）的长期疗效和安全性，并优化该治疗方法的临床实用性。对于其他既定治疗方法被拒绝或存在禁忌的情况，我们对132例ATN患者进行了治疗（男性30例，女性102例，年龄47.5±12.9岁；均值±标准差）。85例患者为毒性腺瘤，47例患有毒性前期结节。在超声引导下每周注射乙醇，共注射7次（范围为2 - 16次）。在PEI治疗期间，26例老年毒性患者接受了甲巯咪唑和普萘洛尔治疗。确定了三种可能的结果用于统计分析：失败（结节外组织摄取持续受抑制，同时游离甲状腺激素升高且促甲状腺激素水平不可测）；部分治愈（游离甲状腺激素正常且促甲状腺激素水平低/不可测）；完全治愈（甲状腺激素和促甲状腺激素水平正常；结节外摄取恢复）。对患者进行了长达8.5年的随访（中位时间76个月）。所有患者对PEI治疗耐受性良好，不过约30%的注射过程中出现了轻度至中度的局部疼痛。所有毒性前期患者以及60例（70.6%）毒性腺瘤患者实现了完全治愈，11例（12.9%）患者出现部分治愈，14例（16.5%）患者治疗失败。所有患者的结节体积均出现显著缩小（p = 0.0001），而毒性结节大于30 mL的患者对PEI的反应率显著较低（p < 0.05）。在对照检查中，仅1例患者出现亚临床甲状腺功能减退，在部分治愈的患者中，有5例复发。甲巯咪唑和/或普萘洛尔的使用并未改变PEI的治疗结果。总之，我们建议对于毒性前期甲状腺腺瘤患者，尽管结节体积大小，PEI治疗可能是最不需要治疗时的首选治疗方法。虽然毒性甲状腺结节的乙醇注射治疗可能因需要多次注射而麻烦，但对于手术风险高的患者以及禁忌使用放射性碘的年轻患者而言，它似乎是一种有效的替代方法。由于干预操作需要特殊的技术技能，PEI治疗可能仅适用于居住在有经验中心附近的患者。
