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投稿时间：2024-10-07 网络发布日期：2025-07-21
投稿时间：2024-10-07 网络发布日期：2025-07-21
中文摘要: 目的 探讨微波消融（MWA）治疗甲状腺良性大结节的疗效，以及安全性。方法 纳入2013年3月至2018年10月于江苏省人民医院和江苏省省级机关医院行超声引导下MWA术的甲状腺大结节患者。共纳入191例患者的397个结节。所有甲状腺结节均经超声引导细针穿刺细胞学检查（FNA）诊断为良性。主要结节的体积均＞20 mL。记录术中及术后并发症。评估治疗后1、3、6、12、24个月时的结节体积。比较不同性质、不同体积结节MWA治疗后的体积变化及其体积缩小率（VRR）。分析不同体积和性质结节的消融能量与VRR的相关性。结果 随着时间的延长，消融后3种不同成分的结节（实性组77例，囊性组95例，混合性组19例）VRR均逐渐增加，在体积上存在时间、组间和交互作用（F时间=39.288，P时间＜0.01；F组间=6.177，P组间＜0.01；F交互=4.299，P交互＜0.01）。根据结节的体积分为20~30 mL组95例，＞30~40 mL组45例，＞40 mL组51例，不同体积的结节存在时间、组间和交互作用（F时间=159.085，P时间＜0.01；F组间=34.861，P组间＜0.01；F交互=10.323，P交互＜0.01）。相关分析表明，微波治疗总能量和单位体积能量均与24个月时的VRR呈负相关（P<0.05）。本研究中，治疗主要相关并发症为疼痛（90.1%），另有9例患者（4.7%）经历了一过性声音变化。结论 MWA是甲状腺大结节治疗的一种安全及有效方法。并且囊性成分体积越大，MWA效果越好；初始体积越大，消融效果越明显。MWA的能量与VRR呈负相关。
Abstract:Objective To retrospectively evaluate the efficacy and safety of microwave ablation （MWA）in the treatment of large benign thyroid nodules. Methods Patients with large thyroid nodules who underwent ultrasound- guided MWA at Jiangsu Province Hospital and Jiangsu Province Official Hospital from March 2013 to October 2018 were included. A total of 191 patients with 397 nodules were enrolled. All nodules were confirmed as benign by ultrasound-guided fine-needle aspiration cytology（FNA）， with the main nodule volume＞20 mL. Intraoperative and postoperative complications were recorded. Nodule volume was assessed at 1，3，6，12，and 24 months post-treatment. Volume changes and volume reduction rate（VRR）were compared among nodules of different compositions and sizes. The correlation between ablation energy and VRR was analyzed based on nodule volume and composition.Results Over time，the VRR of all three nodule types（solid group 77 cases；cystic group 95 cases；mixed group 19 cases）progressively increased，with significant effects observed for time ，group，and their interaction（Ftime=39.288，Ptime＜0.01；Fgroup=6.177，Pgroup<0.01；Finteraction=4.299，Pinteraction＜0.01）. When stratified by volume［（20-30 mL group（95 cases）； ＞30-40 mL group（45 cases）；＞40 mL group（51 cases）］，significant effects were also found for time，group，and interaction（Ftime= 159.085，Ptime ＜0.01；Fgroup=34.861，Pgroup ＜0.01；Finteraction= 10.323，Pinteraction ＜0.01）. Correlation analysis showed that both total microwave energy and energy per unit volume were negatively correlated with VRR at 24 months（P<0.05）. The main treatment-related complication was pain（90.1%），and 9 patients（4.7%）experienced transient voice changes.Conclusion MWA is a safe and effective treatment for large benign thyroid nodules. Greater cystic content and larger initial nodule volume were associated with better ablation outcomes. Ablation energy was negatively correlated with VRR.
文章编号： 中图分类号：R581 文献标志码：A
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引用文本：
吴丹,范伯强,徐婷,等.超声引导下微波消融甲状腺良性大结节的疗效和安全性研究[J].中国临床研究,2025,38(7):1061-1064.
吴丹,范伯强,徐婷,等.超声引导下微波消融甲状腺良性大结节的疗效和安全性研究[J].中国临床研究,2025,38(7):1061-1064.