比较射频消融与微波消融在良性甲状腺结节再治疗中的疗效

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中文摘要

背景： 射频消融与微波消融在良性甲状腺结节再治疗中的比较疗效仍不清楚。本研究比较了良性、以实性为主的甲状腺结节在距上次热消融≥12个月后接受射频消融与微波消融再治疗的12个月体积缩小率。
方法： 纳入连续接受射频消融或微波消融作为再治疗的患者。纳入标准为：（1）细胞学良性、以实性为主（≥80%）的甲状腺结节；（2）既往接受过热消融；（3）再治疗距上次热消融至少1年；（4）完成再治疗后12个月随访。再治疗后12个月内接受进一步热消融、手术或放射性碘治疗的患者被排除。主要结局为再治疗后的12个月体积缩小率＝再治疗前体积－12个月体积/再治疗前体积×100%。比较并发症、压迫症状和美容症状。
结果： 2022年至2024年，46例患者的46个结节（射频消融：23个，微波消融：23个）符合分析条件。任何热消融前的基线结节体积（射频消融：33.6 mL [20.6-50.7 mL] 对微波消融：31.0 mL [17.2-47.8 mL]，P = .442）和再治疗前（射频消融：17.0 [12.7-25.0 mL] 对微波消融：17.3 mL [12.8-27.5 mL]，P = .717）具有可比性。再治疗的中位间隔为23个月（17-39）。再治疗后总体12个月体积缩小率为76.9%（60.7%-82.3%），射频消融与微波消融之间无显著差异（72.4% [56.0-85.1%] 对77.3% [60.7-81.5%]，P = .915）。从任何热消融前基线达到的最终体积缩小率为86.8%（69.3-92.0%），组间具有可比性（射频消融：87.7% [62.9%-93.4%] 对微波消融：85.3% [75.1%-89.7%]，P = .852）。未发生声带麻痹或血肿。再治疗后美容症状改善（P = .005）。
结论： 对于既往接受过热消融治疗的大良性实性甲状腺结节，≥12个月后再次治疗可导致结节进一步缩小。在此时间间隔下，射频消融或微波消融再治疗的疗效和安全性相当。

英文摘要

BACKGROUND: The comparative efficacy of radiofrequency ablation versus microwave ablation for the retreatment of benign thyroid nodules remains less known. This study compared the 12-month volume reduction rate after retreatment with radiofrequency ablation versus microwave ablation, spaced ≥12 months from the last thermal ablation, for benign, predominantly solid thyroid nodules.
METHODS: Consecutive patients undergoing radiofrequency ablation or microwave ablation as a retreatment were considered. The inclusion criteria were (1) cytologically benign, predominantly solid (≥80%) thyroid nodules; (2) previous thermal ablation; (3) retreatment spaced at least 1 year from the last thermal ablation; (4) completed 12-month follow-up after retreatment. Patients receiving further thermal ablation, surgery, or radioiodine within 12 months of retreatment were excluded. The primary outcome was 12-month volume reduction rate after retreatment = volume before retreatment - 12-month volume/volume before retreatment × 100%. Complications, compressive, and cosmetic symptoms were compared.
RESULTS: From 2022 to 2024, 46 nodules (radiofrequency ablation: 23, microwave ablation: 23) from 46 patients were eligible for analysis. Baseline nodule volumes prior to any thermal ablation (radiofrequency ablation: 33.6 mL [20.6-50.7 mL] versus microwave ablation: 31.0 mL [17.2-47.8 mL], P = .442) and prior to retreatment (radiofrequency ablation: 17.0 [12.7-25.0 mL] vs microwave ablation: 17.3 mL [12.8-27.5 mL], P = .717) were comparable. The median interval to retreatment was 23 months (17-39). The overall 12-month volume reduction rate following retreatment was 76.9% (60.7%-82.3%), with no significant difference between radiofrequency ablation and microwave ablation (72.4% [56.0-85.1%] vs 77.3% [60.7-81.5%], P = .915). The final volume reduction rate achieved from baseline prior to any thermal ablation was 86.8% (69.3-92.0%) and comparable between groups (radiofrequency ablation: 87.7% [62.9%-93.4%] versus microwave ablation: 85.3% [75.1%-89.7%], P = .852). No vocal cord palsy or hematoma occurred. Cosmetic symptoms improved after retreatment (P = .005).
CONCLUSION: For large benign solid thyroid nodules that were previously treated with thermal ablation, retreatment at ≥12 months later led to further nodule shrinkage. Retreatment with radiofrequency ablation or microwave ablation at this time interval was comparably effective and safe.