目的

比较甲状腺微小乳头状癌射频消融和外科手术治疗的效果、患者术后的生活质量及心理状况。

方法

选择2020 年1 月至2023 年3 月在浙江大学医学院附属第一医院确诊为甲状腺微小乳头状癌的107 例射频消融组患者与536 例外科手术组患者进行倾向性评分匹配（PSM）。匹配变量包括年龄、结节位置及最大结节体积。射频消融组患者术后1、3、6 个月通过超声检查测量结节体积变化。采用χ² 检验或t 检验比较2 组患者术后并发症、复发情况、手术及住院时间、甲状腺激素水平变化、生活质量、心理焦虑与抑郁情况的差异，并通过多元线性回归分析术后生活质量和心理状况的影响因素。

结果

PSM 后，2 组患者均为107 例，与外科手术组比较，射频消融组手术时间短[（30.05±5.95）min vs （57.15±7.01 min）]、住院时间短[（3.08±1.06）d vs （6.56±1.27）d]、住院费用低[（10 274.92±984.88）元 vs （14 802.46±2409.91）元]，差异均具有统计学意义（t=-30.48、-21.79、-17.99，P 均＜0.001）。2 组均无严重并发症发生，射频消融组3 例（2.8%）患者出现轻微并发症，外科手术组8 例（7.5%），但差异无统计学意义（P＞0.05）。术后复发率方面，射频消融组为2.8%，外科手术组为0.9%，差异也无统计学意义（P＞0.05）。射频消融组术后甲状腺功能较术前无显著变化，而外科手术组出现促甲状腺激素显著升高、游离三碘甲状腺原氨酸和游离甲状腺素较术前显著下降（P 均＜0.05）。射频消融组患者术后1、3、6 个月结节体积变化显著。生活质量评分中躯体健康综合分（PCS）、精神健康综合分（MCS）和生活质量总分射频消融组高于外科手术组[（83.89±9.25）分 vs （78.15±10.93）分；（79.10±8.39）分 vs （74.07±9.28）分；（81.49±6.46）分 vs （76.11±6.82）分]，Zung 自评焦虑量表（SAS）和Zung 自评抑郁量表（SDS）标准分射频消融组低于外科手术组[（46.75±6.57）分 vs （50.34±7.66）分；（54.30±7.18）分 vs （56.58±7.77）分]，差异均具有统计学意义（t=4.32、3.89、5.67、2.22、2.18，P＜0.001、＜0.001、＜0.001、=0.027、=0.030）。多元线性回归分析显示，手术方式（外科手术）和SAS 标准分是影响患者术后总体生活质量的主要因素（β=-7.49、0.84，P 均＜0.001），手术方式（外科手术）、手术费用、PCS 和MCS 是影响患者术后焦虑和抑郁水平的主要因素（β=6.17、0.00，0.39、0.36，P＜0.001、=0.025、＜0.001、＜0.001）。

结论

超声引导下的射频消融治疗甲状腺微小乳头状癌效果良好，具有较低的手术创伤、较低的费用和较高的患者生活质量。相较于外科手术，射频消融可作为一种安全且有效的替代治疗方案，可改善患者术后生活质量和心理状况。

Objective

To comprehensively compare the efficacy, postoperative quality of life, and psychological status in patients undergoing radiofrequency ablation (RFA) versus surgical treatment for papillary thyroid microcarcinoma (PTMC), with the aim of providing clinicians with evidence for treatment decision-making and improving patients’ postoperative quality of life and psychological health.

Methods

A total of 107 patients who were diagnosed with PTMC and underwent radiofrequency ablation at the First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and March 2023 were selected and subjected to propensity score matching (PSM) with 536 PTMC patients who underwent surgical operation.Matching variables included age, nodule location, and maximum nodule volume.In the radiofrequency ablation group, the changes in nodule volume were measured by ultrasound at 1, 3, and 6 months after the operation.The χ² test or t-test was used to compare the differences in postoperative complications, recurrence, operation and hospitalization time, changes in thyroid hormone levels, quality of life, psychological anxiety, and depression between the two groups.Additionally,multiple linear regression analysis was performed to identify the influencing factors of postoperative quality of life and psychological status.

Results

After PSM, there were 107 patients in each group.Compared with the surgical operation group, the radiofrequency ablation group had significantly shorter operation time [(30.05±5.95)min vs (57.15±7.01) min, t=-30.48, P＜0.001] and hospitalization time [(3.08±1.06) d vs (6.56±1.27) d, t=-21.79, P＜0.001], and lower hospitalization costs [(10274.92±984.88) yuan vs (14802.46±2409.91) yuan, t=-17.99, P＜0.001].There were no serious complications in either group.Three cases (2.8%) in the radiofrequency ablation group and eight cases (7.5%) in the surgical operation group had minor complications, with no statistically significant difference in the rate of complications between the two groups (P＞0.05).In terms of postoperative recurrence rate, it was 2.8% in the radiofrequency ablation group and 0.9% in the surgical operation group, with no statistically significant difference (P＞0.05).There were no significant changes in thyroid function after the operation in the radiofrequency ablation group, while in the surgical operation group, there was a significant increase in thyroid-stimulating hormone (TSH) and significant decrease in free triiodothyronine (FT3) and free thyroxine (FT4) (P＜0.05).There were significant differences in the nodule volume changes at 1, 3, and 6 months after the operation in the radiofrequency ablation group.The scores of physical health (PCS), mental health (MCS),and overall quality of life in the radiofrequency ablation group were significantly higher than those of the surgical operation group [(83.89±9.25) points vs (78.15±10.93) points, t=4.32, P＜0.001; (79.10±8.39) points vs(74.07±9.28) points, t=3.89, P＜0.001; (81.49±6.46) points vs (76.11±6.82) points, t=5.67, P＜0.001], and the standard scores of the Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) in the radiofrequency ablation group were significantly lower than those of the surgical operation group [(46.75±6.57)points vs (50.34±7.66) points, t=2.22, P=0.027; (54.30±7.18) points vs (56.58±7.77) points, t=2.18, P=0.0.030].Surgical approach and SAS standard score were main factors influencing the patients’ overall postoperative quality of life (β=-7.49 and 0.84, respectively; both P＜0.001).Surgical approach, surgical costs, and PCS and MCS scores were main factors influencing the patients’ postoperative anxiety and depression levels (β=6.17, 0.00, 0.39,and 0.36; P＜0.001, =0.025, ＜0.001, and ＜0.001, respectively).

Conclusion

Ultrasound-guided radiofrequency ablation is an effective treatment for papillary thyroid microcarcinoma with less surgical trauma, reduced costs,and improved postoperative quality of life.Compared to surgical treatment, radiofrequency ablation is a safe and effective alternative, improving patients’ quality of life and psychological well-being.