射频消融与手术切除在去除分化型甲状腺癌<sup>131</sup>I治疗前过多残留甲状腺组织的对比研究

doi:10.3877/cma.j.issn.1672-6448.2018.04.009

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. 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. 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: 2190005@zju.edu.cn

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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/OL]. 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/OL]. 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

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

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

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

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

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