2025 , Vol. 22 >Issue 05: 444 - 450
DOI: https://doi.org/10.3877/cma.j.issn.1672-6448.2025.05.010
甲状腺微小乳头状癌射频消融与外科手术治疗效果的多角度对比
Copy editor: 吴春凤
收稿日期: 2025-03-04
网络出版日期: 2025-07-17
基金资助
国家重大科研仪器研制项目（82027803）
版权
Radiofrequency ablation versus surgical treatment for papillary thyroid microcarcinoma: a multidimensional comparative study
Received date: 2025-03-04
Online published: 2025-07-17
Copyright
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。
戴璐璐 , 潘金花 , 孔余霞 , 蒋天安 . 甲状腺微小乳头状癌射频消融与外科手术治疗效果的多角度对比[J]. 中华医学超声杂志（电子版）, 2025 , 22(05) : 444 -450 . DOI: 10.3877/cma.j.issn.1672-6448.2025.05.010
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.
±s 表示，使用独立样本t 检验进行2 组间差异分析。使用倾向性评分匹配（propensity score matching，PSM）方法匹配2组患者，采用最近邻匹配法（1∶1），卡钳值设为logit（PS）的0.2 倍标准差，匹配变量包括年龄、结节位置及最大结节体积3 项混杂因素[19]。应用多元线性回归分析评估手术方式对患者生活质量和心理健康的影响。P＜0.05 为差异有统计学意义。表1 2 组甲状腺微小乳头状癌患者临床特征比较 |
| 项 目 | 射频消融组(n=107) | 外科手术组(n=536) | 统计值 | P值 |
|---|---|---|---|---|
| 性别[例(%)] | χ2=2.52 | 0.113 | ||
| 男性 | 37(34.6) | 142(26.5) | ||
| 女性 | 70(65.4) | 394(73.5) | ||
| 年龄(岁，x̄ ± s) | 40.88±11.88 | 43.83±12.62 | t=2.24 | 0.026 |
| 文化程度[例(%)] | χ2=0.40 | 0.525 | ||
| 本科及以上 | 30(28.0) | 170(31.7) | ||
| 本科以下 | 77(72.0) | 366(68.3) | ||
| 医保类型[例(%)] | χ2=0.00 | 0.996 | ||
| 公费 | 99(92.5) | 499(93.1) | ||
| 自费 | 8(7.5) | 37(6.9) | ||
| 结节数量[例(%)] | χ2=2.80 | 0.245 | ||
| 1个 | 94(87.9) | 443(82.6) | ||
| 2个 | 9(8.4) | 77(14.4) | ||
| 3个 | 4(3.7) | 16(3.0) | ||
| 结节位置[例(%)] | χ2=11.04 | 0.004 | ||
| 单侧 | 97(90.7) | 457(85.3) | ||
| 双侧 | 4(3.7) | 68(12.7) | ||
| 峡部 | 6(5.6) | 11(2.1) | ||
| 是否复发[例(%)] | χ2=1.87 | 0.173 | ||
| 否 | 104(97.2) | 532(99.3) | ||
| 是 | 3(2.8) | 4(0.7) | ||
| 并发症[例(%)] | 3(2.8) | 40(7.5) | χ2=0.29 | 0.593 |
| TSH(mlU/L,x̄ ± s) | 1.92±0.21 | 1.89±0.24 | t=1.12 | 0.663 |
| FT3(pmol/L,x̄ ± s) | 4.36±0.89 | 4.40±0.27 | t=-0.58 | 0.763 |
| FT4(pmol/L,x̄ ± s) | 13.25±1.67 | 13.38±1.86 | t=-0.73 | 0.843 |
| 手术时间(min,x̄ ± s) | 30.05±5.95 | 58.67±6.87 | t=-45.94 | <0.001 |
| 手术费用(元，x̄ ± s) | 10274.92±984.88 | 15064.77±2431.06 | t=-25.48 | <0.001 |
| 住院时间(d,x̄ ± s) | 3.08±1.06 | 7.09±2.86 | t=-17.93 | <0.001 |
| 最大结节体积(mm³,x̄ ± s) | 60.72±24.62 | 67.98±27.92 | t=-2.50 | 0.013 |
注：FT3 为游离三碘甲状腺原氨酸，FT4 为游离甲状腺素，TSH 为促甲状腺激素 |
表2 通过倾向性评分匹配后2 组甲状腺微小乳头状癌患者基线临床资料比较 |
| 项 目 | 射频消融组(n=107) | 外科手术组(n=107) | 统计值 | P值 |
|---|---|---|---|---|
| 年龄(岁， x̄ ± s) | 40.88±11.88 | 41.37±12.63 | t=-0.30 | 0.768 |
| 结节位置[例(%)] | χ2=0.00 | 1.000 | ||
| 单侧 | 97(90.7) | 97(90.7) | ||
| 双侧 | 4(3.7) | 4(3.7) | ||
| 峡部 | 6(5.6) | 6(5.6) | ||
| 最大结节体积(mm³,x̄ ± s) | 60.72±24.62 | 62.59±26.45 | t=-0.54 | 0.592 |
| 并发症[例(%)] | 3(2.8) | 8(7.5) | χ2=1.81 | 0.178 |
| 复发率[例(%)] | 3(2.8) | 1(0.9) | χ2=0.98 | 0.332 |
| 手术时间(min,x̄ ± s) | 30.05±5.95 | 57.15±7.01 | t=-30.48 | <0.001 |
| 手术费用(元， x̄ ± s) | 10274.92±984.88 | 14802.46±2409.91 | t=-17.99 | <0.001 |
| 住院时间(d,x̄ ± s) | 3.08±1.06 | 6.56±1.27 | t=-21.79 | ≤0.001 |
表3 通过倾向性评分匹配后2 组甲状腺微小乳头状癌患者甲状腺功能手术前后变化（ |
| 组别 | 例数 | FT3(pmol/L) | FT4(pmol/L) | TSH(mIU/L) |
|---|---|---|---|---|
| 外科手术组 | 107 | |||
| 术前 | 4.39±0.82 | 13.51±1.75 | 1.87±0.32 | |
| 术后 | 3.65±0.60 | 12.16±1.91 | 2.25±0.69 | |
| t值 | 11.39 | 9.82 | -10.33 | |
| P值 | <0.001 | <0.001 | <0.001 | |
| 射频消融组 | 107 | |||
| 术前 | 4.36±0.89 | 13.25±1.67 | 1.92±0.21 | |
| 术后 | 4.43±0.56 | 13.10±0.31 | 1.94±0.22 | |
| t值 | -1.34 | -1.33 | -0.48 | |
| P值 | 0.183 | 0.192 | 0.637 |
注：FT3 为游离三碘甲状腺原氨酸，FT4 为游离甲状腺素，TSH为促甲状腺激素 |
表4 2 组甲状腺微小乳头状癌患者术后生活质量和心理状态比较（分， |
| 项目 | 射频消融组 （n=107） | 外科手术组 （n=107） | t 值 | P 值 |
|---|---|---|---|---|
| 生活质量 | ||||
| 生理功能 | 84.11±10.50 | 80.79±11.70 | 2.72 | <0.001 |
| 生理职能 | 88.08±21.26 | 74.30±29.63 | 0.62 | 0.534 |
| 躯体疼痛 | 84.95±27.00 | 82.80±23.38 | 1.90 | 0.059 |
| 一般健康状况 | 78.41±13.36 | 74.72±15.03 | 1.65 | 0.101 |
| 精力 | 78.22±10.01 | 75.84±11.11 | 2.75 | 0.006 |
| 社会功能 | 80.14±15.35 | 74.07±16.44 | 2.49 | 0.014 |
| 情感职能 | 80.69±26.32 | 70.40±33.75 | 1.14 | 0.256 |
| 精神健康 | 77.35±8.89 | 75.96±8.87 | 3.10 | <0.001 |
| PCS | 83.89±9.25 | 78.15±10.93 | 4.32 | <0.001 |
| MCS | 79.10±8.39 | 74.07±9.28 | 3.89 | <0.001 |
| 生活质量总分 | 81.49±6.46 | 76.11±6.82 | 5.67 | <0.001 |
| 心理状态 | ||||
| SAS 标准分 | 46.75±6.57 | 50.34±7.66 | 2.22 | 0.027 |
| SDS 标准分 | 54.30±7.18 | 56.58±7.77 | 2.18 | 0.030 |
注：PCS 为躯体健康综合分，等于（生理功能+生理职能+躯体疼痛+一般健康状况）/4；MCS 为精神健康综合分，等于（精力+社会功能+情感职能+精神健康）/4；SAS 为Zung 自评焦虑量表，SDS为Zung 自评抑郁量表 |
表5 影响甲状腺微小乳头状癌患者术后生活质量的多元线性回归分析结果 |
| 参数 | β值 | 标准误 | t 值 | P 值 |
|---|---|---|---|---|
| 手术方式：外科手术 | -7.49 | 0.76 | -9.80 | <0.001 |
| SAS 标准分 | 0.84 | 0.04 | 18.95 | <0.001 |
| SDS 标准分 | -0.02 | 0.04 | -0.39 | 0.695 |
| 手术费用 | 0.00 | 0.00 | -1.71 | 0.088 |
| 住院时间 | -0.01 | 0.13 | -0.08 | 0.936 |
| 年龄 | -0.02 | 0.02 | -1.05 | 0.296 |
| 性别：女 | 0.23 | 0.45 | 0.52 | 0.602 |
| 医保类型：自费 | -0.44 | 0.86 | -0.51 | 0.608 |
| 文化程度：本科以下 | 0.22 | 0.48 | 0.45 | 0.652 |
| 结节位置：双侧 | -0.06 | 1.14 | -0.05 | 0.957 |
| 结节位置：峡部 | -0.37 | 0.95 | -0.39 | 0.699 |
| 最大结节体积 | 0.00 | 0.01 | -0.30 | 0.761 |
注：SAS 为Zung 自评焦虑量表，SDS 为Zung 自评抑郁量表 |
表6 2 组甲状腺微小乳头状癌患者心理状态的多元线性回归分析结果 |
| 参数 | β值 | 标准误 | t 值 | P 值 |
|---|---|---|---|---|
| PCS | 0.39 | 0.02 | 16.95 | <0.001 |
| MCS | 0.36 | 0.03 | 13.08 | <0.001 |
| 手术方式：外科手术 | 6.17 | 0.77 | 8.06 | <0.001 |
| 手术费用 | 0.00 | 0.00 | 2.26 | 0.025 |
| 住院时间 | -0.05 | 0.12 | -0.38 | 0.702 |
| 年龄 | 0.02 | 0.02 | 1.16 | 0.247 |
| 性别：女 | -0.39 | 0.42 | -0.92 | 0.358 |
| 医保类型：自费 | -0.10 | 0.82 | -0.12 | 0.902 |
| 文化程度：本科以下 | 0.09 | 0.45 | 0.20 | 0.845 |
| 结节位置：双侧 | -0.53 | 1.08 | -0.49 | 0.624 |
| 结节位置：峡部 | 2.03 | 0.89 | 2.28 | 0.024 |
| 最大结节体积 | 0.00 | 0.01 | -0.19 | 0.850 |
注：PCS 为躯体健康综合分，MCS 为精神健康综合分 |
| 1 |
Davies L, Welch HG.Increasing incidence of thyroid cancer in the United States, 1973-2002 [J].JAMA, 2006, 295(18): 2164-2167.
|
| 2 |
Dou Z, Shi Y, Jia J.Global burden of disease study analysis of thyroid cancer burden across 204 countries and territories from 1990 to 2019[J].Front Oncol, 2024, 14: 1412243.
|
| 3 |
Wei Y, Niu WQ, Zhao ZL, et al.Microwave ablation versus surgical resection for solitary T1N0M0 papillary thyroid carcinoma [J].Radiology, 2022, 304(3): 704-713.
|
| 4 |
Sugitani I, Ito Y, Takeuchi D, et al.Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma:consensus statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma [J].Thyroid, 2021, 31(2): 183-192.
|
| 5 |
Chen DW, Lang BHH, Mcleod DSA, et al.Thyroid cancer [J].Lancet,2023, 401(10387): 1531-1544.
|
| 6 |
Zhang M, Luo Y, Zhang Y, et al.Efficacy and safety of ultrasoundguided radiofrequency ablation for treating low-risk papillary thyroid microcarcinoma: a prospective study [J].Thyroid, 2016, 26(11): 1581-1587.
|
| 7 |
Lim HK, Cho SJ, Baek JH, et al.US-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: efficacy and safety in a large population [J].Korean J Radiol, 2019, 20(12): 1653-1661.
|
| 8 |
Jeon MJ, Kim WG, Kim TY, et al.Active surveillance as an effective management option for low-risk papillary thyroid microcarcinoma [J].Endocrinol Metab (Seoul), 2021, 36(4): 717-724.
|
| 9 |
Sasaki T, Miyauchi A, Ito Y, et al.Marked decrease over time in conversion surgery after active surveillance of low-risk papillary thyroid microcarcinoma [J].Thyroid, 2021, 31(2): 217-223.
|
| 10 |
Teng DK, Li WH, Du JR, et al.Effects of microwave ablation on papillary thyroid microcarcinoma: a five-year follow-up report [J].Thyroid, 2020, 30(12): 1752-1758.
|
| 11 |
Wu R, Luo Y, Tang J, et al.Ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a retrospective analysis of 198 patients [J].Int J Hyperthermia, 2020, 37(1): 168-174.
|
| 12 |
赵冬夏, 黄钰, 曹凌强.射频消融治疗、手术切除治疗甲状腺结节的临床应用对比研究 [J].罕少疾病杂志, 2024, 31(8): 33-34.
|
| 13 |
付伟娟, 江艳丽, 胡举.超声引导下射频消融与外科手术治疗低风险甲状腺微小乳头状癌患者的疗效比较 [J].实用癌症杂志, 2024,39(6): 933-935, 946.
|
| 14 |
Xu D, Ge M, Yang A, et al.Expert consensus workshop report:Guidelines for thermal ablation of thyroid tumors (2019 edition) [J].J Cancer Res Ther, 2020, 16(5): 960-966.
|
| 15 |
Cao XJ, Yu MA, Zhu YL, et al.Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study [J].Int J Hyperthermia, 2021, 38(1): 916-922.
|
| 16 |
Zu Y, Liu Y, Zhao J, et al.A cohort study of microwave ablation and surgery for low-risk papillary thyroid microcarcinoma [J].Int J Hyperthermia, 2021, 38(1): 1548-1557.
|
| 17 |
Roest AM, Martens EJ, De Jonge P, et al.Anxiety and risk of incident coronary heart disease: a meta-analysis [J].J Am Coll Cardiol, 2010,56(1): 38-46.
|
| 18 |
中华人民共和国国家卫生健康委员会医政医管局.甲状腺癌诊疗指南（2022 年版） [J].中国实用外科杂志, 2022, 42(12): 1343-1357, 1363.
|
| 19 |
付凤娟, 史守荣, 王圣明.微波消融与射频消融治疗甲状腺良性结节的安全性及近期有效性 [J].内蒙古医学杂志, 2024, 56(4): 491-494.
|
| 20 |
Chmielik E, Rusinek D, Oczko-Wojciechowska M, et al.Heterogeneity of thyroid cancer [J].Pathobiology, 2018, 85(1-2): 117-129.
|
| 21 |
侯修强, 冯创, 黄文连, 等.基于倾向性评分匹配比较不同术式治疗甲状腺微小乳头状癌的效果 [J].安徽医药, 2023, 27(11): 2186-2190, 2335.
|
| 22 |
Haugen BR, Alexander EK, Bible KC, et al.2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer [J].Thyroid, 2016, 26(1): 1-133.
|
| 23 |
Zeng F, Zou B, Chen H, et al.Analysis of therapeutic effect and influencing factors of ultrasound-guided radiofrequency ablation in the treatment of papillary thyroid microcarcinoma [J].J Ultrasound Med,2023, 42(8): 1769-1777.
|
| 24 |
Zhang M, Tufano RP, Russell JO, et al.Ultrasound-guided radiofrequency ablation versus surgery for low-risk papillary thyroid microcarcinoma: results of over 5 years’ follow-up [J].Thyroid, 2020,30(3): 408-417.
|
| 25 |
Rosato L, Pacini F, Panier Suffat L, et al.Post-thyroidectomy chronic asthenia: self-deception or disease? [J].Endocrine, 2015, 48(2): 615-620.
|
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