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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） ›› 2023, Vol. 20 ›› Issue (02) : 227 -231. doi: 10.3877/cma.j.issn.1672-6448.2023.02.012

浅表器官超声影像学

超声引导下射频消融治疗甲状腺微小乳头状癌的长期大样本随访研究
阎琳1, 兰雨1, 谢芳1, 罗渝昆1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心超声诊断科
  • 收稿日期:2020-08-17 出版日期:2023-02-01
  • 通信作者: 罗渝昆
  • 基金资助:
    北京市科技计划项目(Z221100003522001)

Long-term clinical outcomes of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma

Lin Yan1, Yu Lan1, Fang Xie1, Yukun Luo1,†()   

  1. 1. Department of Ultrasound, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2020-08-17 Published:2023-02-01
  • Corresponding author: Yukun Luo
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阎琳, 兰雨, 谢芳, 罗渝昆. 超声引导下射频消融治疗甲状腺微小乳头状癌的长期大样本随访研究[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(02): 227-231.

Lin Yan, Yu Lan, Fang Xie, Yukun Luo. Long-term clinical outcomes of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(02): 227-231.

目的

探讨超声引导下射频消融治疗单发低危甲状腺微小乳头状癌的大样本、长期随访结果。

方法

选取2014年6月至2017年5月在解放军总医院行射频消融治疗的单发低危甲状腺微小乳头状癌患者349例，随访时间均大于36个月，其中女性273例，男性76例，肿瘤平均直径（5.23±1.58）mm，体积中位数为65.45（93.46）mm3。射频消融术后1、3、6、12个月及随后每半年行超声和超声造影检查评估消融灶体积、颈部淋巴结及甲状腺实质情况，分析疗效及预后。

结果

患者的平均随访时间为（45.94±10.05）个月，病灶体积中位数由65.45（93.46）mm3缩小至0 mm3，体积缩小率中位数为100%。末次随访时，共307枚病灶消失（87.11%，307/349）。所有患者的手术均顺利进行，未发生严重并发症。18枚病灶在术后3个月消失，另有12枚在术后6个月消失，319枚消融灶术后进行了粗针穿刺活检，结果显示无肿瘤残留。射频消融术后13例患者出现复发转移，总复发率为3.72%（13/349），无远处转移发生。其中4例患者出现淋巴结转移（1.15%，4/349），9例患者出现肿瘤复发（2.58%，9/349）。13例患者中12例进行了射频消融治疗，末次随访时，10枚复发或转移病灶消失、2枚病灶体积缩小。

结论

大样本、长期随访研究表明，超声引导下射频消融可安全有效地治疗低危单发甲状腺微小乳头状癌。

关键词: 射频消融, 甲状腺微小乳头状癌, 超声检查, 随访研究
Objective

To assess the long-term clinical outcomes of radiofrequency ablation (RFA) for low-risk unifocal papillary thyroid microcarcinoma (PTMC) in a large population.

Methods

From June 2014 to May 2017, 349 patients (273 females and 76 males; age range,18 to 73 years) with low-risk unifocal PTMC were treated by RFA at the First Medical Centre of Chinese PLA General Hospital. The mean diameter was (5.23±1.58) mm and the median volume was 65.45 (93.46) mm3. The patients were followed by ultrasound and contrast-enhanced ultrasound (CEUS) at 1, 3, 6, 12 months and every 6-12 months thereafter. The volume reduction was calculated. Recurrence and lymph node or distant metastasis were evaluated.

Results

The mean follow-up time was (45.94±10.05) months. The median initial volume decreased form 65.45 (93.46) mm3 to 0 mm3, with a median volume reduction rate of 100%. No life-threatening or delayed complications occurred. Since 18 and 12 ablated areas disappeared at 3 and 6 months, respectively, 319 ablated areas underwent post-ablation core-needle biopsy, and the results were all negative. A total of 13 patients developed local tumor recurrence and the overall incidence of local tumor progression was 3.72%. Among them, 4 patients (1.15%) developed lymph node metastasis and 9 (2.58%) had recurrent PTMC. A total of 12 patients underwent additional RFA, among which the lesions completely disappeared during the follow-up period in 10 cases, and two lesions decreased in size.

Conclusions

RFA is an effective and safe treatment for low-risk unifocal PTMC, which could become a first-line treatment for low-risk PTMC.

Key words: Radiofrequency ablation, Papillary thyroid microcarcinoma, Ultrasonography, Follow-up study
表1 射频消融治疗前后甲状腺微小乳头状癌的体积及体积缩小率变化情况［M（QR），n=349］
时间 体积（mm3） Z值 P值 体积缩小率（%）
消融前 65.45（93.46） - - -
消融即刻 753.96（581.18） -16.167 <0.001 -
术后1个月 293.21（287.97） -14.979 <0.001 -348.00（526.22）
术后3个月 87.96（138.23） -3.710 <0.001 -14.33（202.89）
术后6个月 18.85（64.40） -7.834 <0.001 43.12（75.00）
术后12个月 0（6.28） -13.702 <0.001 100.00（8.00）
术后18个月 0 -12.665 <0.001 100
术后24个月 0 -15.312 <0.001 100
术后36个月 0 -13.008 <0.001 100
术后48个月 0 -10.120 <0.001 100
图1 射频消融治疗甲状腺微小乳头状癌术前及术后随访超声图像。图a为消融术前超声显示甲状腺右叶低回声结节，体积为109.95 mm3（箭头所示）；图b 为消融术后即刻，超声造影显示消融灶呈无增强区（箭头所示），体积为1310.94 mm3；图c，d分别为消融术后3、6个月，消融灶体积逐渐缩小，分别为4.19 mm3 和3.14 mm3（箭头所示）；图e为射频消融术后12个月，超声显示病灶消失
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