目的:评估不同保留剂量的超声引导下脊髓灰质炎化学消融术对良性囊性甲状腺结节的影响。
方法:于2019年12月至2022年1月进行了回顾性研究,包括78例良性囊性甲状腺结节患者,其中31只接受了脊髓灰质炎化学消融,23人接受了polidocanol化学加热消融,24人接受了开放性手术。接受polidocanol化学消融的患者根据polidocanol的保留剂量:0%,10%,20%,30%,和50%。术后1、3、6和12个月进行随访。结节的体积,术后并发症,在治疗前和随访期间检查结节的复发。
结果:接受消融的患者的总手术时间和术中出血量明显低于接受开放手术的患者(P<0.001)。在脊髓灰质炎化学消融组的患者中,术后1、3、6个月,10%保留剂量组甲状腺结节体积收缩率明显低于0%保留剂量组(P<0.05)。30%保留剂量组术后12个月结节收缩率最高(98.46±1.55%),显著高于50%保留剂量组(P<0.05)。在policocanol化学和热消融组的患者中,10%和30%保留剂量组术后1个月甲状腺结节的体积收缩率明显低于0%保留剂量组(P<0.05)。尽管热消融后20%保留剂量组的体积收缩率高于0%保留剂量组,差异无统计学意义(P>0.05)。在不良反应方面,开放手术组的声音嘶哑和咳嗽的发生率高于polidocanol化学消融和polidocanol化学和热消融组,但差异无统计学意义(P>0.05)。
结论:脊髓灰质炎化学消融治疗良性囊性甲状腺结节安全有效,最佳保留剂量可以在20%和30%之间。单纯化学消融疗效差的患者可以通过热消融接受安全有效的治疗。
OBJECTIVE: To assess the influence of varying retention doses of ultrasound-guided
polidocanol chemical ablation for benign cystic-solid thyroid nodules.
METHODS: A retrospective study was conducted from December 2019 to January 2022, including 78 patients with benign cystic-solid thyroid nodules, of which 31 received polidocanol chemical ablation alone, 23 received
polidocanol chemical plus thermal ablation, and 24 received open surgery. Patients who received
polidocanol chemical ablation were assigned into groups based on the retention dose of
polidocanol: 0 %, 10 %, 20 %, 30 %, and 50 %. Follow-ups were done at 1, 3, 6, and 12 months postoperatively. The volume of the nodules, postoperative complications, and recurrence of the nodules were examined before treatment and during follow-up visits.
RESULTS: Total operation time and intraoperative bleeding volume for patients who received ablation were substantially lower than those for patients who received open surgery (P < 0.001). Among patients in the
polidocanol chemical ablation group, volume shrinkage rate of thyroid nodules in the 10 % retention dose group was significantly lower than that in the 0 % retention dose group at 1, 3, and 6 months postoperatively (P < 0.05). The 30 % retention dose group had the highest nodule shrinkage rate (98.46 ± 1.55 %) at 12 months postoperatively, which was significantly higher than that in the 50 % retention dose group (P < 0.05). Among patients in the polidocanol chemical and thermal ablation group, the volume shrinkage rate of thyroid nodules in the 10 % and 30 % retention dose groups at 1 month postoperatively was significantly lower than that in the 0 % retention dose group (P < 0.05). Although volume shrinkage rate in the 20 % retention dose group after thermal ablation was higher than that in the 0 % retention dose group, the difference was not statistically significant (P > 0.05). In terms of adverse reactions, the incidence of hoarseness and coughing was higher in the open surgery group than in the polidocanol chemical ablation and polidocanol chemical and thermal ablation groups, but there was no significant difference (P > 0.05).
CONCLUSIONS: Chemical ablation with polidocanol was safe and effective for therapy of benign cystic-solid thyroid nodules, and the optimal retention dose may be between 20 % and 30 %. Patients with poor efficacy from chemical ablation alone can receive safe and effective treatment through thermal ablation.