基于病例报道及文献的系统分析，为早期识别结节破裂提供诊治经验。

报道大连医科大学附属第一医院就诊的3例热消融术后结节破裂病例，同时综述2019年1月至2025年5月国内外文献中的64例病例，系统分析术后结节破裂的好发因素、发生时间、临床表现、影像特征及治疗方式。

本中心报道的3例热消融术后结节破裂病例，二维及超声造影显示甲状腺被膜连续性中断、腺体外占位中央无增强伴周边等增强表现。病例1伴脓肿形成，经抽吸引流后症状好转，病例2（外院消融伴皮肤烧伤）、病例3（二次消融时机过早）经保守治疗均痊愈。64例热消融术后结节破裂病例资料分析：破裂中位发生时间为术后28 d；71.9%（46/64）的患者表现为颈部疼痛，28.1%（18/64）的患者伴肿胀；95.3%（61/64）的患者超声显示甲状腺被膜连续性中断；90.0%（36/40）为前型破裂；86.2%（50/58）的破裂发生于初始直径＞2.75 cm的结节；89.7%（52/58）的患者首选保守治疗，完全缓解率为50.0%；10.3%（6/58）的患者初始选择侵入性治疗，且均达到临床完全缓解。

甲状腺热消融术后结节破裂好发于较大直径结节，破裂类型以前型破裂为主，中位发生时间为术后28 d，临床多表现为颈部疼痛，二维及超声造影可明确诊断，保守治疗部分有效，侵入性治疗可提高治疗成功率。

Informed by case reports and systematic analysis of the literature, this study aims to offer diagnostic and treatment insights for the early identification of nodule rupture.

This study reports on three cases of nodule rupture following thermal ablation at the First Affiliated Hospital of Dalian Medical University, along with a systematic review of 64 cases from the literature published from January 2019 to May 2025, encompassing an analysis of predisposing factors, time of occurrence, clinical manifestations, imaging features, and treatment strategies associated with nodule rupture.

Among the three cases of nodule rupture following thermal ablation reported at our center, two-dimensional ultrasound and contrast-enhanced ultrasound showed thyroid capsular discontinuity and an extrathyroidal mass with central non-enhancement and peripheral isoenhancement. Case 1 was complicated by abscess formation, with symptom relief achieved through aspiration and drainage; Case 2 experienced nodule rupture secondary to skin burns following ablation performed at an external institution; and Case 3 experienced rupture due to the premature timing of repeat ablation. Both Case 2 and Case 3 achieved complete symptom resolution with conservative management. A systematic review of 64 cases of nodule rupture following thermal ablation revealed that the median time to onset was 28 days postoperatively, 71.9% (46/64) of patients presented with neck pain and 28.1% (18/64) with neck swelling. Ultrasound imaging showed thyroid capsular discontinuity in 95.3% (61/64) of cases. Among the 40 cases with reported rupture type 90.0% (36/40) presented with anterior-type rupture. Additionally, among 58 cases reporting the correlation between initial nodule size and rupture, 86.2% (50/58) had an initial maximum diameter＞2.75 cm. Finally, 89.7% (52/58) of patients initially received conservative management, achieving a complete resolution rate of 50.0% (26/52), while 10.3% (6/58) underwent invasive treatment as the primary intervention.

Nodule rupture following thyroid thermal ablation most frequently occurs in larger nodules and is predominantly characterized by anterior type rupture, with a median time to onset of 28 days postoperatively. Neck pain is the most common clinical manifestation. Two-dimensional ultrasound, in combination with contrast-enhanced ultrasound, plays a critical role in the diagnosis. Conservative treatment is effective in some cases, while invasive treatments can improve overall treatment success.