射频消融术治疗甲状腺良性结节术后结节再生的影响因素分析-现代医学

射频消融术治疗甲状腺良性结节术后结节再生的影响因素分析

单位：1. 南京中医药大学附属中西医结合医院超声科, 江苏南京 210028;
2. 中国药科大学附属浦口中医院内分泌科, 江苏南京 210028

分类号：R581.9

出版年·卷·期（页码）：2025·53·第九期（1459-1466）

摘要：

目的： 评估射频消融术治疗甲状腺良性结节术后结节再生情况，并分析其影响因素。方法： 选取2021年1月至2022年12月于南京中医药大学附属中西医结合医院超声科收治的187例患者(242个甲状腺结节)为研究对象。对研究对象进行甲状腺射频消融，并收集患者基本信息及不同随访时间的结节体积和结节体积缩小率(VRR)；单、多因素Cox回归分析射频消融后结节大小的影响因素。结果： 本研究患者共纳入187例，其中女148例(191个结节)，男39例(51个结节)。术后1、3、6、12个月结节VRR逐渐升高。VRR与单位体积消融时长(r=0.165，P=0.017)、是否钙化(r=0.165，P=0.017)、RADS分类(r=0.169，P=0.014)、结节边界是否清晰(r=0.169，P=0.014)及性别(r=0.140，P=0.044)呈正相关，与结节内血流(r=-0.221，P=0.001)、结节周围血流(r=-0.227，P=0.001)及结节体积(r=-0.200，P=0.005)呈负相关。实性成分(HR=3.879，P=0.037)、混合回声(HR=9.008，P=0.045)、结节周围血流丰富(HR=3.840，P=0.020)及单位体积消融时长(HR=1.001，P=0.022)是影响术后结节再生的危险因素。结论： 结节再生与结节成分，初始体积，结节内部、周边外血流分布情况呈显著相关。结节的实性成分、混合回声、结节周围血流丰富及单位体积消融时长是影响再生的危险因素。

Objective: To evaluate the radiofrequency ablation for benign thyroid nodules and to analyze the factors influencing post-procedural nodule regrowth. Methods: A total of 187 patients(242 thyroid nodules) treated at the Department of Ultrasonography, Hospital of Integrated Traditional and Western Medicine Affiliated to Nanjing University of Chinese Medicine between January 2021 and December 2022 were enrolled. All patients underwent thyroid radiofrequency ablation. Patient baseline characteristics, nodule volume, and volume reduction rate(VRR) at various follow-up time points were collected. Univariate and multivariate Cox regression analyses were performed to identify factors influencing nodule regrowth after radiofrequency ablation. Results: The study included 187 patients, comprising 148 females(191 nodules) and 39 males(51 nodules). The VRR progressively increased at 1, 3, 6, and 12 months post-operation. VRR showed positive correlations with ablation time per unit volume(r=0.165, P=0.017), presence of calcification(r=0.165, P=0.017), RADS classification(r=0.169, P=0.014), nodule boundary clarity(r=0.169, P=0.014), and gender(r=0.140, P=0.044). Negative correlations were observed between VRR and intranodular blood flow(r=-0.221, P=0.001), perinodular blood flow(r=-0.227, P=0.001), and initial nodule volume(r=-0.200, P=0.005). Multivariate Cox analysis identified solid composition(HR=3.879, P=0.037), mixed echogenicity(HR=9.008, P=0.045), abundant perinodular blood flow(HR=3.840, P=0.020), and longer ablation time per unit volume(HR=1.001, P=0.022) as independent risk factors for nodule regrowth. Conclusion: Nodule regrowth is significantly associated with nodule composition, initial volume, and the distribution of intra- and perinodular blood flow. Solid composition, mixed echogenicity, abundant perinodular blood flow, and longer ablation time per unit volume are risk factors for regrowth.

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