US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules
US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules
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DOI：
10.1016/j.ultrasmedbio.2007.10.018
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发表时间：
2008-05-01
影响因子：
2.9
通讯作者：
Garberoglio, Roberto
中科院分区：
文献类型：
--
作者：
Deandrea, Maurilio;Limone, Paolo;Garberoglio, Roberto
本研究的目的是确定超声引导下经皮射频（RF）热消融治疗良性甲状腺结节的有效性和安全性。31例不适合手术或放射性碘（I-131）治疗的患者接受了良性结节的射频消融术;共治疗了33个结节（2例患者在同一疗程中治疗了2个结节）：10个冷结节和23个功能亢进。14例患者主诉压迫症状。分别于治疗前、治疗后1、3、6个月评价患者的甲状腺体积、甲状腺功能和压迫症状。超声引导射频消融使用Starbust RITA（R）针进行，带有9个可扩展的尖头;在95 ℃下，在结节的一个或多个区域的总暴露时间为6至10分钟。基线体积（射频消融时测量）为27.7 +/- 21.5 mL（平均值+/- SD），但在随访期间显著降低：1个月时为19.2 ± 16.2（-32.7%; p < 0.001），3个月时15.9 +/- 14.1 mL（-46.4%; p < 0.001），6个月时14.6 +/- 12.6 mL（-50.7%; p < 0.001）。治疗后，所有冷结节患者甲状腺功能正常：5例热结节患者甲状腺功能正常，其余16例甲状腺功能亢进症部分缓解。除了颈部发热和轻度肿胀外，未观察到重大并发症。13名患者报告压迫症状改善，严重程度量表从6.1 +/- 1.4降至2.2 +/- 1.9（p < 0.0001）。放射治疗在减少体积约50%和大良性结节的压迫症状方面是有效和安全的。24%的患者功能亢进得到完全控制，其他患者功能亢进部分减轻。
The aim of the study was to define the effectiveness and safety of ultrasound-guided percutaneous radiofrequency (RF) thermal ablation in the treatment of compressive solid benign thyroid nodules. Thirty-one patients not eligible for surgery or radioiodine (I-131) treatment underwent RF ablation for benign nodules; a total of 33 nodules were treated (2 patients had 2 nodules treated in the same session): 10 cold nodules and 23 hyperfunctioning. Fourteen patients complained of compressive symptoms. Nodule volume, thyroid function and compressive symptoms were evaluated before treatment and at 1, 3 and 6 mo. Ultrasound-guided RF ablation was performed using a Starbust RITA (R) needle, with nine expandable prongs; total exposure time was 6 to 10 min at 95 degrees C in one area or more of the nodule. Baseline volume (measured at the time of RF ablation) was 27.7 +/- 21.5 mL (mean +/- SD), but significantly decreased during follow-up: 19.2 +/- 16.2 at 1 mo (-32.7%; p < 0.001), 15.9 +/- 14.1 mL at 3 mo (-46.4 %; p < 0.001) and 14.6 +/- 12.6 mL at 6 mo (-50.7%; p < 0.001). After treatment, all patients with cold nodules remained euthyroid: five patients with hot nodules normalized thyroid function, and the remaining sixteen showed a partial remission of hyperthyroidism. Besides a sensation of heat and mild swelling of the neck, no major complications were observed. Improvement in compressive symptoms was reported by 13 patients, with a reduction on severity scale from 6.1 +/- 1.4 to 2.2 +/- 1.9 (p < 0.0001). Radiofrequency was effective and safe in reducing volume by about 50% and compressive symptoms in large benign nodules. Hyperfunction was fully controlled in 24% of patients and partially reduced in the others.