超声引导下甲状腺微波消融术对结节性甲状腺肿患者围手术期指标及甲状腺功能的影响

Effect of ultrasound-guided microwave ablation on perioperative indicators and thyroid function in patients with nodular goiter

摘要:

目的 探究超声引导下甲状腺微波消融术（MWA）对结节性甲状腺肿患者围手术期指标及甲状腺功能的影响。方法 选取2021年1月—2024年5月南京医科大学第一附属医院接收的86例结节性甲状腺肿患者，按手术方法分为传统组（42例）和MWA组（44例）。传统组给予传统开放式手术治疗，MWA组给予MWA治疗。比较两组临床疗效、围手术期指标、疼痛程度、甲状腺功能、结节容积缩小率（VRR）及并发症。结果 MWA组的手术时间、术中出血量、住院时间及手术瘢痕均低于传统组（P <0.05）。MWA组与传统组术后3 h、1 d、3 d的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =564.998，P =0.000）；②MWA组与传统组VAS评分比较，差异有统计学意义（F =182.571，P =0.000），MWA组VAS评分均低于传统组；③两组VAS评分变化趋势比较，差异有统计学意义（F =34.265，P =0.000）。MWA组手术前后游离三碘甲腺原氨酸、游离甲状腺素和促甲状腺激素的差值均低于传统组（P <0.05）。术后1、3、6个月，MWA组的VRR分别为（48.29±6.84）%、（67.48±8.48）%、（85.45±11.12）%，差异有统计学意义（P <0.05）。MWA组的并发症总发生率低于传统组（P <0.05）。结论 相比于传统开放式手术治疗结节性甲状腺肿，MWA围手术期指标改善更显著，疼痛程度更低、对甲状腺功能影响更小，但短期的结节清除率较低。

Abstract:

Objective To investigate the effects of ultrasound-guided microwave ablation (MWA) on perioperative indicators and thyroid function in patients with nodular goiter.Methods A total of 86 patients with nodular goiter, treated from January 2021 to May 2024 at the First Affiliated Hospital of Nanjing Medical University, were divided into the traditional surgery group (n = 42) and the MWA group (n = 44) based on the surgical method. The traditional group received conventional open surgery, whereas the MWA group was treated with ultrasound-guided MWA. The clinical efficacy, perioperative indicators, pain levels, thyroid function, nodule volume reduction rate (VRR), and complications were compared between the two groups.Results The MWA group had shorter operative duration, less intraoperative blood loss, shorter length of hospital stays, and less surgical scarring compared to the traditional surgery group (P < 0.05). Comparison of the Visual Analog Scale (VAS) scores 3 hours, 1 day, and 3 days after surgery in the MWA group and the traditional surgery group revealed that they were different among the time points (F =564.998, P =0.000) and between the groups (F =182.571, P =0.000), where the VAS scores in the MWA group were lower than those in the traditional surgery group. The change trends of VAS scores were also different between the two groups (F =34.265, P =0.000). The differences in levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) before and after surgery in the MWA group were all lower than those in the traditional surgery group (P < 0.05). At 1 month, 3 months, and 6 months postoperatively, the VRRs in the MWA group were 48.29 ± 6.84%, 67.48±8.48%, and 85.45 ± 11.12%, respectively, with statistically significant differences (P < 0.05). The complication rate in the MWA group was lower than that in the traditional surgery group (P < 0.05).Conclusion Compared with traditional open surgery for nodular goiter, MWA shows more significant improvements in perioperative indicators, results in lower pain levels, and has a smaller impact on thyroid function. However, its short-term nodule clearance rate is relatively lower.