评估超声(US)引导下射频消融(RFA)治疗原发性甲状旁腺功能亢进(PHPT)的疗效和安全性。
这项前瞻性研究招募了39名参与者(14名男性,25名女性;平均年龄,59.5±15.3[范围,18-87]年),介于2018年9月1日至2021年1月31日之间。所有参与者都有导致PHPT的甲状旁腺病变,证明生物化学和通过成像。PHPT结节的影像学特征,包括形状,margin,尺寸,composition,和位置,在治疗前进行评估。血清完整甲状旁腺激素,钙,治疗前后记录磷水平;甲状旁腺结节体积;PHPT相关症状。我们计算了技术上的成功,生化治疗,以及这些患者的临床治愈率。在消融期间和之后评估并发症。
在39名参与者的39个结节中,38个实现了完全消融。所有患者均在一个疗程中接受治疗。技术成功率为97.4%(38/39)。平均随访时间为13.2±4.6(范围,6.0-24.9)个月。RFA后6个月和12个月,生化治愈率分别为82.1%(32/39)和84.4%(27/32),分别,临床治愈率分别为100%(39/39)和96.9%(31/32),分别。只有2.6%(1/39)的患者出现PHPT复发。在RFA技术成功后的1、3、6和12个月,44.7%(17/38),34.3%(12/35),15.8%(6/38),12.5%(4/32)的参与者,分别,甲状旁腺激素水平升高。5.1%(2/39)的患者发生喉返神经麻痹,在1-3个月内自发康复。
美国指导的RFA对PHPT患者有效且安全。RFA可能是无法耐受或拒绝接受手术的患者的替代治疗工具。
To assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT).
This prospective
study enrolled 39 participants (14 male, 25 female; mean age, 59.5 ± 15.3 [range, 18-87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation.
Complete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 ± 4.6 (range, 6.0-24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1-3 months.
US-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.