甲状腺结节热消融治疗适应证扩展的研究进展

doi:10.16150/j.1671-2870.2024.04.011

摘要/Abstract

摘要：

甲状腺结节作为一种常见的内分泌系统肿瘤，全球范围内甲状腺结节的总发病率在2000年至2022年间约为25%，其中甲状腺恶性结节的发生率为4.0%~6.5%。近年来，热消融技术在甲状腺结节治疗中的适应证逐渐扩大，而禁忌证亦相应减少。热消融技术已被广泛应用于治疗良性甲状腺结节。研究表明，射频消融和微波消融在减小甲状腺结节体积和缓解症状方面具有显著疗效。传统甲状腺消融的适应症包括甲状腺功能亢进（如格雷夫斯病、毒性结节性甲状腺肿）、甲状腺良性结节、甲状腺癌术后辅助治疗及不适合手术或复发性甲状腺疾病的患者。随着研究的深入，甲状腺结节热消融治疗的适应症不断的扩大。对于胸骨后甲状腺结节，治疗后的体积减少率达到90%以上；对于钙化性良性结节，5年随访显示平均体积减少率为92.95%。针对甲状腺滤泡性肿瘤，研究指出超过一半的甲状腺滤泡性肿瘤结节在热消融治疗1年后体积减少率达到90%，且治疗组的并发症发生率较低。在甲状腺恶性肿瘤方面，热消融技术在治疗T_1aN₀M₀期单灶低风险乳头状甲状腺微小癌方面显示出良好效果，疾病进展发生率低至3.6%。对于T_1bN₀M₀期至T₂N₀M₀期原发单灶乳头状甲状腺癌，研究结果表明，热消融治疗的预后与手术相当，且并发症发生率更低。在多灶性甲状腺乳头状癌患者中，热消融治疗的成功率为100%，且随访期内局部肿瘤进展率低。对于位于峡部、临近气管或紧贴包膜的甲状腺乳头状微小癌患者，热消融治疗显示出与手术相似的疗效，且并发症发生率和复发率较低。本文就热消融技术在甲状腺结节治疗中的适应证扩展进行综述，为临床应用提供参考。

关键词: 甲状腺结节, 热消融, 超声介入, 适应证

Abstract:

Thyroid nodules, a common endocrine tumor, have shown a significant increase in incidence globally. The total incidence rate of thyroid nodules worldwide is about 25% from 2000 to 2022, of which the incidence of malignant thyroid nodules is 4.0% to 6.5%. In recent years, the application of thermal ablation technology in the treatment of thyroid nodules has been steadily increasing, with broader indications and fewer contraindications. Thermal ablation techniques have been widely applied in the treatment of benign thyroid nodules. Studies have demonstrated that radiofrequency ablation (RFA) and microwave ablation (MWA) significantly reduce nodule volume and alleviate symptoms. For retrosternal thyroid nodules, the post-treatment volume reduction rate exceeds 90%. For calcified benign nodules, a five-year follow-up showed an average volume reduction rate of 92.95%. Studies on follicular tumors indicated that more than half of the nodules achieved a 90%-volume reduction one year after thermal ablation, with a low incidence of complications in the treatment group. In the treatment of malignant thyroid tumors, thermal ablation has shown promising results in T_1aN₀M₀ solitary low-risk papillary thyroid microcarcinoma (PTMC), with a disease progression rate as low as 3.6%. For T_1bN₀M₀-T₂N₀M₀ primary solitary papillary thyroid carcinoma (PTC), the prognosis following thermal ablation is comparable to surgery, with a lower incidence of complications. In patients with multifocal PTC, the success rate of thermal ablation was 100%, with a low rate of local tumor progression during follow-up. For PTMC located in the isthmus, adjacent to the trachea, or close to the thyroid capsule, thermal ablation demonstrated similar efficacy to surgery, with lower rates of complications and recurrence. This review summarizes the current indications of thermal ablation technology in the treatment of thyroid nodules and provides a reference for clinical applications.

Key words: Thyroid nodules, Thermal ablation, Ultrasound intervention, Indications

中图分类号:

杨逸轩, 周建桥. 甲状腺结节热消融治疗适应证扩展的研究进展[J]. 诊断学理论与实践, 2024, 23(04): 424-429.

YANG Yixuan, ZHOU Jianqiao. Advances in the study of indications for thermal ablation therapy of thyroid nodules[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(04): 424-429.

图/表 1

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