背景:射频消融(RFA)是一种微创门诊手术,最近已成为自主功能甲状腺结节(AFTNS)的治疗选择,提供了一种侵入性较小的手术替代方案。本系统评价和荟萃分析的目的是评估RFA对AFTN的疗效。
方法:PubMed的全球数据库,Scopus,Embase,WebofScience,从1990年到2024年1月5日,对CochraneLibrary进行了系统搜索,以获取有关接受RFA的AFTN的研究,这些研究显示了术后随访1、3、6或12个月中至少一个的体积减少率(VRR),结果以方法表示。主要结果是VRR和TSH复常率,次要结果是美容评分,症状评分,和术后并发症。异质性通过Cochrane和I2统计来评估,并使用随机效应模型进行荟萃分析。研究方案在PROSPERO(CRD42024499932)上注册。
结果:共纳入10项符合条件的研究,总样本量为254例。RFA治疗后1、3、6和12个月的合并VRR为46.6%(95%CI:40.3-52.9%),62%(95%CI:57.6-66.4%),67.4%(95%CI:62.3-72.6%),和77.2%(95%CI:79.2-81.5%),分别。TSH正常化的总体率为76.4%(95%CI:58.1-88.4%)。根据纳入的研究,亚临床甲状腺功能减退症作为该方法最重要的副作用之一的总体发生率为4%(95%CI:1.9%-8.1%)。
结论:RFA成为AFTNS的一种有希望的非手术治疗方法,显示高TSH正常化率,肿瘤大小缩小,改善美容和症状评分。然而,需要进一步研究比较RFA与手术方法,并评估长期结局.
BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive outpatient procedure that has recently emerged as a treatment option for autonomous functioning thyroid nodules (AFTNs), offering a less invasive alternative to surgery. The objective of this systematic
review and meta-analysis is to evaluate the efficacy of RFA for AFTNs.
METHODS: Global databases of PubMed, Scopus, Embase, Web of Science, and Cochrane Library were systematically searched from 1990 until January 5, 2024, for studies on AFTNs undergoing RFA that presented volume reduction ratio (VRR) for at least one of 1, 3, 6 or 12 months post-operative follow-up with the results presented as means. The primary outcomes were VRR and TSH normalization rate, and the secondary outcomes were the cosmetic score, symptom score, and post-procedure complications. Heterogeneity was assessed by Cochrane and I2 statistics, and a random-effects model was used for meta-analysis. The study protocol was registered on PROSPERO (CRD42024499932).
RESULTS: A total of 10 eligible studies with a total sample size of 254 were included. The pooled VRR after 1, 3, 6, and 12 months of follow-up post-treatment with RFA was 46.6% (95% CI: 40.3-52.9%), 62% (95% CI: 57.6-66.4%), 67.4% (95% CI:62.3-72.6%), and 77.2% (95% CI: 79.2-81.5%), respectively. The overall rate of TSH normalization was 76.4% (95% CI: 58.1-88.4%). Based on included studies the overall rate of subclinical hypothyroidism as one of the most important side effects of this method was 4% (95% CI: 1.9%-8.1%).
CONCLUSIONS: RFA emerges as a promising non-surgical treatment for AFTNs, showing high rates of TSH normalization, tumor size reduction, and improved cosmetic and symptom scores. However, further research is needed to compare RFA with surgical methods and assess long-term outcomes.