| 蒋贤贤,叶显俊.超声引导下微波消融联合术中无水乙醇硬化治疗囊实性甲状腺结节 45例疗效评价[J].安徽医药,2024,28(9):1746-1750. |
| 超声引导下微波消融联合术中无水乙醇硬化治疗囊实性甲状腺结节 45例疗效评价 |
| Evaluation of the therapeutic effect of ultrasound-guided microwave ablation combined with intraoperative anhydrous ethanol sclerotherapy for cystic-solid thyroid nodules: an analysis of 45 cases |
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| DOI：10.3969/j.issn.1009-6469.2024.09.012 |
| 中文关键词: 甲状腺结节 超声引导下微波消融术 乙醇 治疗结果 |
| 英文关键词: Thyroid nodules Ultrasound-guided microwave ablation (US-MWA) Ethanol Treatment outcomes |
| 基金项目:中国博士后科学基金第 73批面上资助项目( 2023M733390) |
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| 中文摘要: |
| 目的回顾性研究超声引导下微波消融联合术中无水乙醇硬化治疗囊实性甲状腺结节的疗效评价。方法连续纳入 2018年 7月至 2021年 10月于中国科学技术大学附属第一医院确诊为良性甲状腺囊实性结节的 93例病人，行超声引导下微波消融联合术中无水乙醇硬化术(试验组， n=45)和超声引导下单纯微波消融术(对照组， n=48)。比较两组术后 1、3、6、12个月结节体积及容积缩小率( VRR)、单位体积消融时间、单位体积消耗能量、消融功率、美容评分、疼痛评分、术中囊内出血率及并发症。结果试验组 VRR术后 1个月(48.74±11.32)%、3个月(68.31±9.00)%、6个月(81.09±7.99)%、12个月(89.28±5.72)%均高于对照组［(31.11±14.65)%，(52.55±13.40)%，(69.49±8.34)%，(85.54±4.70)%］(P<0.05)试验组结节体积术后 1个月(10.35±4.57) cm3、3个月( 6.25±2.53)cm3、6个月( 3.61±1.65)cm3、12个月( 1.36±0.87)cm3均低于对照，组［( 13.45±5.60)cm3(8.95±3.47)cm3，(5.71±2.16)cm3，(2.66±0.97)cm3］(P<0.05)随着时间延长，两组结节体积呈逐渐缩小趋势，两组 VRR呈逐渐增大趋势；试验组单位体积消融时间、单位体积消耗能量均低于对照组( P<0.05)；试验组术后美容评分及术后即刻疼痛评分均低于对照组( P<0.05)；试验组术中囊内出血发生率低于对照组(P<0.05)；单位体积消融时间、单位体积消耗能量、术中囊内出血率、术后即刻疼痛评分与疗效呈负相关( rs=-0.38，-0.39，-0.55，-0.83，P<0.05)。结论微波消融联合术中无水乙醇硬化术治疗囊实性甲状腺结节较单纯微波消融术具有疗效更突出、美容效果更好，疼痛度更低等优势，值得临床推广应用。 |
| 英文摘要: |
| Objective To retrospectively evaluate the efficacy of ultrasound-guided microwave ablation combined with intraoperative anhydrous ethanol sclerotherapy in the treatment of cystic-solid thyroid nodules. Methods Ninety-three consecutive patients diag-nosed with benign cystic solid thyroid nodules at the First Hospital of the University of Science and Technology of China from July2018 to October 2021, who underwent respectively ultrasound-guided microwave ablation combined with intraoperative anhydrous etha- nol sclerotization (experimental group, n=45) and ultrasound-guided microwave ablation alone (control group, n=48), were included. Acomparison was made of the nodule volume reduction rate (VRR), ablation time per unit volume, energy consumption per unit volume,ablation power, cosmetic score, pain score, intraoperative intracapsular bleeding rate, and complications between the two groups at 1, 3,6, and 12 months after surgery.Results VRRs of the experimental group 1 month, 3 months, 6 months, and 12 months after surgerywere all significantly higher than those of the control group [ (48.74±11.32)% vs. (31.11±14.65)%, (68.31±9.00)% vs. (52.55±13.40)%, (81.09±7.99)% vs. (69.49±8.34)%, (89.28±5.72)% vs. (85.54±4.70)%, respectively] (P<0.05). The volumes of nodules in the experimen-tal group 1 month, 3 months, 6 months, and 12 months after surgey were significantly lower than those in the control group [(10.35±4.57) cm3 vs. (13.45±5.60) cm3, (6.25±2.53) cm3 vs. (8.95±3.47) cm3, (3.61±1.65) cm3 vs. (5.71±2.16) cm3, (1.36±0.87) cm3 vs. (2.66± 0.97) cm3, respectively](P<0.05). With the prolongation of the time, the nodule volumes of the two groups showed a tendency of gradualreduction, and the VRRs of the two groups showed a tendency of gradual increase.The ablation time per unit volume and energy con-sumption per unit volume of the experimental group were significantly lower than those of the control group (P<0.05). The postoperativecosmetic score and immediate postoperative pain scoreof the experimental group were significantly lower than those of the control group(P<0.05). The incidence of intraoperative intracapsular hemorrhage in the experimental group was lower than that of the control group,and the difference was statistically significant (P<0.05). The use time of ablation needle per unit volume, energy consumption per unitvolume, intraoperative intracapsular hemorrhage rate, and immediate postoperative pain score were negatively correlated with the effica-cy (rs=-0.38,-0.39,-0.55,-0.83, respectively; P<0.05).Conclusion The combination of microwave ablation and intraoperative anhy- drous ethanol sclerotherapy for the treatment of cystic-solid thyroid nodules has advantages of better therapeutic effect, better cosmeticeffect, and lower pain, which is worthy of clinical promotion and application. |
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