微波消融术治疗甲状腺良性结节的疗效及影响因素分析

Analysis of therapeutic effect and prognostic factors of microwave ablation for benign thyroid nodules

摘要:

目的 探讨微波消融术治疗甲状腺良性结节的疗效及其预后的影响因素。方法 选取2018年9月—2019年5月在成都医学院第一附属医院进行微波消融术治疗甲状腺良性结节的患者122例。所有患者随访6个月，观察结节体积，根据结节体积缩小率将其分为预后良好组及预后不良组。比较两组患者的不同临床资料，采用多因素Logistic回归分析微波消融术治疗甲状腺良性结节后结节消退吸收的影响因素。结果 微波消融术前术后的结节体积比较，差异有统计学意义（P <0.05），术后较术前缩小，且呈持续缩小趋势。预后良好组与预后不良组术前、术后1个月、术后3个月、术后6个月的结节体积比较，采用重复测量设计的方差分析，结果 ①不同时间点的结节体积有差异（P <0.05）；②两组的结节体积有差异（P <0.05），预后良好组结节体积较小，消融效果较好；③两组的结节体积变化趋势有差异（P <0.05）。两组的结节囊实性、单位体积消融时间、桥本甲状腺炎比较，差异有统计学意义（P <0.05）；两组的年龄、性别构成、结节位置、结节数量比较，差异无统计学意义（P >0.05）。多因素Logistic回归分析发现，结节体积大［O^R=38.920（95% CI：2.959，511.864）］，结节实性［O^R=0.005（95% CI：0.001，0.138）］，单位体积消融时间长［O^R=1.046（95% CI：1.019，1.073）］，桥本甲状腺炎［O^R=0.001（95% CI：0.001，0.264）］是影响结节消退吸收的独立危险因素（P <0.05）。结论 微波消融术治疗甲状腺良性结节安全有效，结节体积大、结节实性、单位体积消融时间长、桥本甲状腺炎是影响结节消退吸收的独立危险因素。

Abstract:

Objective To explore the effect of microwave ablation on benign thyroid nodule and its prognostic factors.Methods A total of 122 cases of benign thyroid nodules underwent microwave ablation in our hospital from September 2018 to May 2019 were collected and followed up for six months to observe the reduction of nodules. According to the shrinkage of nodules, they were divided into good prognosis group and poor prognosis group. The different clinicopathological characteristics of the two groups of patients were compared. Multivariate Logistic regression was used to analyze the influencing factors of nodule regression and absorption after microwave ablation for benign thyriod nodules.Results There was significant difference in the volume of benign thyroid nodules before and after microwave ablation (P < 0.05). The nodule volume of good prognosis group was compared with that of poor prognosis group before operation, 1 month, 3 months and 6 months after operation. The analysis of variance of repeated measurement design was used.Results (1) there were differences in nodule volume at different time points (P < 0.05); (2) There was difference in nodule volume between the two groups (P < 0.05). The nodule volume in the group with good prognosis was smaller and the ablation effect was better; (3) There was a trend of change in nodule volume between the two groups (P < 0.05). There were significant differences between the two groups in cystic and solid nodules, ablation time per unit volume and Hashimoto thyroiditis (P < 0.05); there was no significant difference in age, sex composition, nodule location, and nodule number between the two groups (P > 0.05). Multivariate logistic regression analysis showed that large nodule volume [O^R = 38.920 (95% CI: 2.959, 511.864) ], solid nodule [O^R = 0.005 (95% CI: 0.001, 0.138) ], long ablation time per unit volume [O^R = 1.046 (95% CI: 1.019, 1.073) ], and Hashimoto thyroiditis [O^R = 0.001 (95% CI: 0.001, 0.264) ] were independent risk factors affecting nodule regression and absorption (P < 0.05).Conclusion Microwave ablation is safe and effective in the treatment of benign thyroid nodule. Large nodule volume, solid nodule, long ablation time per unit volume, and hashimoto thyroiditis are the independent risk factors for poor prognosis.