Schumm-Draeger P M
Department of Endocrinology, Medical Clinic I, Clinics of JWG-University, Frankfurt/Main, Germany.
Exp Clin Endocrinol Diabetes. 1998;106 Suppl 4:S59-62. doi: 10.1055/s-0029-1212059.
Percutaneous ethanol injection therapy (PEIT) in patients with autonomously functioning thyroid nodules (AFTN) has been evaluated with respect to indication for PEIT, treatment procedure, results of therapy and side effects of this treatment. As PEIT has not been tested against the standard procedure of radioiodine treatment and surgery up to now, PEIT should be an alternative treatment for selected patients who cannot or will not be treated by radioiodine therapy or surgery. The clinical data available demonstrate that better results are obtained in patients with euthyroid AFTN or AFTN with subclinical hyperthyroidism as compared to patients with AFTN and overt hyperthyroidism, particularly in small thyroid nodules (thyroid nodular volume less than 15 ml). After PEIT significant reduction of thyroid nodular volume can be achieved (reduction 21 to 88 %). Adverse events of PEIT are few and usually mild and with special respect to transient dysphonia, strongly correlated with the technical skills of the operator. Limitations of PEIT are mainly the need of repeat ethanol injections in order to achieve a complete cure of AFTN. In conclusion, a prospective controlled randomized clinical study has to be carried out in patients with AFTN in order to define the role of PEIT in comparison to the standard therapies (radioiodine treatment, surgery), in the treatment of patients with AFTN conclusively.
对于自主功能性甲状腺结节（AFTN）患者的经皮乙醇注射疗法（PEIT），已就PEIT的适应症、治疗程序、治疗结果及该治疗的副作用进行了评估。由于迄今为止尚未将PEIT与放射性碘治疗及手术的标准程序进行对比测试，PEIT应作为无法或不愿接受放射性碘治疗或手术的特定患者的替代治疗方法。现有临床数据表明，与患有明显甲亢的AFTN患者相比，甲状腺功能正常的AFTN患者或伴有亚临床甲亢的AFTN患者疗效更佳，尤其是在甲状腺小结节（甲状腺结节体积小于15毫升）患者中。PEIT治疗后可使甲状腺结节体积显著缩小（缩小21%至88%）。PEIT的不良事件较少，通常较轻微，特别是短暂性发音障碍，这与操作者的技术水平密切相关。PEIT的局限性主要在于为实现AFTN的完全治愈需要重复注射乙醇。总之，必须对AFTN患者开展一项前瞻性对照随机临床研究，以便最终确定PEIT与标准疗法（放射性碘治疗、手术）相比在AFTN患者治疗中的作用。
