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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (04) : 281 -286. doi: 10.3877/cma.j.issn.1672-6448.2018.04.009

所属专题： 文献；

浅表器官超声影像学

射频消融与手术切除在去除分化型甲状腺癌131I治疗前过多残留甲状腺组织的对比研究
时开元1, 徐栋2, 郑传铭3, 龙斌4, 游向东5,†()   
  1. 1. 310009　杭州，浙江大学医学院附属第二医院超声科;310022　杭州，浙江省肿瘤医院超声科
    2. 310022　杭州，浙江省肿瘤医院超声科
    3. 310022　杭州，浙江省肿瘤医院头颈外科
    4. 310022　杭州，浙江省肿瘤医院核医学科
    5. 310009　杭州，浙江大学医学院附属第二医院超声科
  • 收稿日期:2018-01-30 出版日期:2018-04-01
  • 通信作者: 游向东
  • 基金资助:
    国家卫生计生委重大疾病防治科技行动计划(ZX-01-C201505)

Comparison of radiofrequency ablation and operation for overmuch residual thyroid removal before 131I treatment in differentiated thyroid cancer

Kaiyuan Shi1, Dong Xu2, Chuanming Zheng3, Bin Long4, Xiangdong You5,†()   

  1. 1. Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
    2. Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou 310022, China
    3. Department of Nuclear Medicine, Zhejiang Cancer Hospital, Hangzhou 310022, China
    4. Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
  • Received:2018-01-30 Published:2018-04-01
  • Corresponding author: Xiangdong You
  • About author:
    Corresponding author: You Xiangdong, Email:
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时开元, 徐栋, 郑传铭, 龙斌, 游向东. 射频消融与手术切除在去除分化型甲状腺癌131I治疗前过多残留甲状腺组织的对比研究[J]. 中华医学超声杂志（电子版）, 2018, 15(04): 281-286.

Kaiyuan Shi, Dong Xu, Chuanming Zheng, Bin Long, Xiangdong You. Comparison of radiofrequency ablation and operation for overmuch residual thyroid removal before 131I treatment in differentiated thyroid cancer[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(04): 281-286.

目的

比较射频消融与手术切除在去除过多残留甲状腺组织（清甲）的有效性与安全性。

方法

选取2014年1月至2016年12月浙江省肿瘤医院收治的分化型甲状腺癌术后拟行131I治疗患者52例，治疗前低碘饮食及停用优甲乐3周后测血清TSH<30 μIU/ml、99mTc甲状腺成像及超声检查提示甲状腺明显残留。28例患者接受射频消融，24例行手术切除。采用t检验比较射频消融与手术切除组的手术时间、131I治疗间隔时间及清甲的效果，同时观察2组的并发症情况。

结果

射频消融组平均用时与手术切除组比较[（22.14±7.12）min vs（55.45±13.56）min]，差异有统计学意义（t=11.822，P<0.05）。131I治疗前平均等待时间手术切除组与射频消融组比较[（13.53±4.55）d vs （9.40±4.14）d]，差异有统计学意义（t=9.144，P<0.05）。RFA组术后出现声音嘶哑、暂时性甲状旁腺损伤、永久性甲状旁腺损伤分别为2例、0例、1例，手术切除组分别为2例、3例、0例，2组间比较，差异均无统计学意义（P均>0.05）。射频消融组131I首次清甲成功24例，成功率85.7%，手术切除组成功22例，成功率91.7%，差异无统计学意义（P>0.05）。

结论

与手术相比，超声引导下射频消融清除分化型甲状腺癌术后残留甲状腺组织同样安全有效，为不愿接受手术切除的患者提供一种新的微创治疗方法。

关键词: 甲状腺肿瘤, 消融技术, 超声检查
Objectives

The aim of this study is to compare efficacy and safety of radiofrequency ablation versus operation for overmuch residual thyroid removal before 131I treatment in differentiated thyroid cancer.

Methods

Clinical data from 52 newly diagnosed differentiated thyroid cancer patients who treated with operation at Zhejiang Cancer Hospital from January 2014 to December 2016 were retrospectively reviewed. The serum TSH was less than 30 IU/ml, and 99mTc thyroid imaging and ultrasound examination showed obviously residual thyroid tissue after 3 weeks of low iodine diet and discontinuation of euthyrox. Of these patients, 28 cases received radiofrequency, while 24 cases treated with operation. The operation time, the waiting time of 131I treatment and the efficacy of residual thyroid tissue clearance were compared between two groups. At the same time, the complications of the two groups were observed.

Results

The mean values of operation time between two groups were (22.14±7.12) min and (55.45±13.56) min, respectively, and there was a statistically significant difference (t=11.822, P<0.05). The mean waiting time of 131I treatment in patients received radiofrequency was (9.40±4.14) days, while the mean waiting time in operation group was (13.53±4.55) days, and the differences were statistically significant (t=9.144, P<0.05). In RFA group, hoarseness, temporary parathyroid injury and permanent parathyroid injury were observed in 2 cases, 0 case and 1 case, respectively. While there were 2 cases, 3 cases and 0 case in the operative group. There were no significant differences between the two groups (all P>0.05). 85.7% (24/28) of patients in RFA group and 91.7% (22/24) in operation group showed favorable efficacy of residual thyroid removal, and there were no significant differences between the two groups (P>0.05).

Conclusion

Compared with operation, postsurgical residual thyroid tissue removal in differentiated thyroid cancer by ultrasound guided radiofrequency ablation by ultrasound guided is safe and effective, and provides a new minimally invasive treatment for patients who are reluctant to undergo surgery.

Key words: Thyroid neoplasms, Ablation techniques, Ultrasonography
表1 射频消融组与手术切除组甲状腺癌患者临床资料比较[例（%）]
临床特征 射频消融组（28例） 手术切除组（24例） χ2值 P值
年龄 ? ? 0.032 0.857
? <30岁 10 8 ? ?
? ≥30岁 18 16 ? ?
性别 ? ? 0.126 0.722
? 男性 7 5 ? ?
? 女性 21 19 ? ?
T分期 ? ? 0.037 0.982
? T2 4 3 ? ?
? T3 15 13 ? ?
? T4 9 8 ? ?
残留腺体部位 ? ? 0.955 0.328
? 单侧 24 18 ? ?
? 双侧 4 6 ? ?
残留腺体体积 ? ? 0.119 0.730
? <3 cm3 13 10 ? ?
? ≥3 cm3 15 14 ? ?
表2 射频消融组与手术切除组甲状腺癌患者并发症发生情况比较[例（%）]
组别 例数 声音嘶哑 暂时甲旁腺损伤 永久甲旁腺损伤
射频消融组 28 2 0 1
手术切除组 24 2 3 0
χ2值 ? 0.026 3.714 0.874
P值 ? 0.872 0.054 0.350
图1~4 患者女性，45岁，甲状腺术后，低碘饮食及停优甲乐3周后，血清促甲状腺激素5.71 μIU/ml。图1为超声及超声造影提示甲状腺左叶明显残留；图2为99mTc甲状腺成像提示甲状腺左叶区明显放射性浓聚，摄锝率为0.7%；图3为射频消融后即刻超声造影提示残叶基本消融完全，术后第3天血清促甲状腺激素31.98 μIU/ml，图4为99mTc甲状腺成像示甲状腺左叶区放射性浓聚影变淡，摄锝率0.2%。
表3 射频消融组与手术切除组的手术时间、等待时间、首次行131I清甲的成功率比较（±s）
组别 例数 平均用时（min） 平均等待时间（d） 术前甲状腺摄锝率（%） 术后甲状腺摄锝率（%）
射频消融组 28 22.14±7.12 9.40±4.14 0.70±0.16 0.31±0.12
手术切除组 24 55.45±13.56 13.53±4.55 0.78±0.16 0.28±0.10
t值 ? 11.822 9.144 0.164 0.184
P值 ? 0.001 0.003 0.702 0.504
[1]
Siegel R,Ma J,Zou Z, et al. Cancer statistics, 2014[J]. CA Cancer J Clin, 2014, 64(1): 9-29.
[2]
中华医学会核医学分会. 131I治疗分化型甲状腺癌指南(2014版)[J]. 中华核医学与分子影像杂志, 2014, 34(4): 264-278.
[3]
Gharib H,Papini E,Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules[J]. J Endocrinol Invest, 2010, 33(5 Suppl): 1-50.
[4]
Xu D,Wang LP,Long B, et al. Radiofrequency ablation for postsurgical thyroid removal of differentiated thyroid carcinoma[J]. Am J Transl Res, 2016, 8(4): 1876-1885.
[5]
Long B,Li L,Yao L, et al. Combined use of radioiodine therapy and radiofrequency ablation in treating postsurgical thyroid remnant of differentiated thyroid carcinoma[J]. J Cancer Res Ther, 2015, 11(8): 244-247.
[6]
Iyer NG,Morris LG,Tuttle RM, et al. Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy[J]. Cancer, 2011, 117(19): 4439-4446.
[7]
Patel SS,Goldfarb M. Well-differentiated thyroid carcinoma: the role of post-operative radioactive iodine administration[J]. J Surg Oncol, 2013, 107(6): 665-672.
[8]
乔法敏. 重复131碘清甲治疗分化型甲状腺癌疗效分析[J]. 现代医药卫生, 2016, 32(23): 3680-3681.
[9]
王立平, 徐栋, 李林法, 等. 射频消融去除分化型甲状腺癌术后残留甲状腺组织初步研究[J]. 中华超声影像学杂志, 2015, 24(6): 549-551.
[10]
Wiggermann P,Zuber-Jerger I,Zausig Y, et al. Contrast-enhanced ultrasound improves real-time imaging of ablation region during radiofrequency ablation: preliminary results[J]. Clin Hemorheol Microcirc, 2011, 49(1-4): 43-54.
[11]
Baek JH,Moon WJ,Kim YS, et al. Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules[J]. World J Surg, 2009, 33(9): 1971-1977.
[12]
王飞亮, 缪刚, 韦军民, 等. 甲状腺全切除术中对甲状旁腺特异性附着脂肪进行保护的临床和解剖研究[J]. 中华外科杂志, 2016, 54(11): 859-863.
[13]
Lappas D,Noussios G,Anagnostis P, et al. Location,number and mor-phology of parathyroid glands: results from a large anatomical series[J]. Anat Sci Int, 2012, 87(3): 160-164.
[14]
Silaghi H,Valea A,Ghervan C, et al. Ectopic intrathyroid parathyroidadenoma: diagnostic and therapeutic challenges due to multiple osteo-lytic lesions[J]. Med Ultrason, 2011, 13(3) :241-244.
[15]
Verburg FA,Lassmann M,Mäder U, et al. The absorbed dose to the blood is a better predictor of ablation success than the administered 131I activity in thyroid cancer patients[J]. Eur J Nucl Med Mol Imaging, 2011, 38(4): 673-680.
[16]
刘晔, 晋建华, 刘建中, 等. 放射性131I去除分化型甲状腺癌术后残留甲状腺组织的疗效与影响因素分析[J]. 中国药物与临床, 2013, 13(5): 556-558.
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