超声引导下经皮微波消融治疗微小甲状腺乳头状癌-现代医学

超声引导下经皮微波消融治疗微小甲状腺乳头状癌

单位：1. 中国人民解放军第181医院普通外科, 广西桂林 541002;
2. 上海411医院外科影像介入, 上海 200080

分类号：R736.1

出版年·卷·期（页码）：2020·39·第三期（373-378）

摘要：

目的：比较微波消融（MWA）和手术治疗乳头状甲状腺微小癌（PTMC）的疗效、安全性和成本效益。方法：2014年5月至2017年1月选取50例接受手术的PTMC患者（手术组）和51例接受MWA治疗的PTMC患者（MWA组）。在36个月的随访期内对两组患者的平均住院时间、费用、平均失血量、手术切口大小、手术时间、并发症和治疗效果进行了比较。结果：两组随访中均未观察到复发或淋巴结转移病例。MWA组的平均住院天数、治疗费用、手术切口大小、平均出血量和手术时间与手术组相比差异均有统计学意义（P<0.05）。MWA组的并发症发生率显著降低（3.9% vs 42.0%，P<0.05）。MWA组的结节体积从（63.75±32.18）mm³降至（2.37±9.88）mm³（P<0.05），体积缩小百分率为（98.74±5.65）%（74.16%~100.00%），8例（15.7%）结节完全消失。结论：MWA在治疗PTMC方面表现出良好的安全性和有效性，与手术治疗相比，MWA侵袭性较小，术后并发症发生率低，有效缩短了住院时间，提高了成本效益。

Objective: To compare the efficacy, safety, and cost-effectiveness of surgery and microwave ablation(MWA) for the treatment of papillary thyroid microcarcinoma (PTMC). Methods: From May 2014 to January 2017, 50 PTMC patients who underwent surgery (surgery group) and 51 patients treated by MWA (MWA group) were enrolled in this study. We compared the two groups in terms of mean length of hospital stay, cost, mean blood loss, surgical incision, operating room time, complications, and therapeutic efficacy over a follow-up period of 36 months. Results: No recurrence or lymph node metastasis was observed during the follow-up in the surgery or the MWA groups. Compared with the surgery group, the average length of hospital stay, treatment cost, surgical incision, mean bleeding volume, and operative time were significantly lower in the MWA group (P<0.05), and the complication rate was significantly lower in the MWA group (42.0% vs 3.9%, P<0.05). The nodule volume at 36 months of follow-up decreased significantly from (63.75±32.18) mm³ to (2.37±9.88) mm³(P<0.05), and the percentage volume reduction was (98.74±5.65)% (range 74.16%-100.00%). Eight (15.7%) patients' nodules completely disappeared in the MWA group.Conclusion: MWA shows a good safety and efficacy for the treatment of PTMC. Compared with surgical treatment, MWA has less invasiveness and lower postoperative complications, which effectively shortens hospital stay and increases cost-effectiveness.

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