冯娅琴　陈方红　陈志辉　谢丽丹

[摘要] 目的 比較超声下射频消融术与甲状腺手术治疗甲状腺良性结节的临床疗效。 方法 将67例甲状腺良性结节患者分为消融组和对照组。对照组采用甲状腺切除术治疗。消融组采用超声下射频消融术治疗。对比两组手术情况及并发症发生情况。术后6个月，检测两组患者甲状腺相关激素变化，检测消融组术后6个月的结节大小。结果 消融组的手术时间、术中失血量、住院时间、手术瘢痕显著低于对照组，差异有统计学意义（P<0.05）；消融组并发症的发生率（8.57%）显著低于对照组（31.25%），差异有统计学意义（P<0.05）；术前和术后6个月，消融组的TSH、TT4、FT3无明显改变（P>0.05）；术后6个月，对照组TSH明显升高，TT4、FT3明显降低（P<0.05）；术后6个月，两组TSH、TT4、FT3对比，差异有统计学意义（P<0.05）；术后6个月，消融组的结节大小显著降低，差异有统计学意义（P<0.05），缩小率为（84.36±7.18）%。 结论 超声下射频消融术治疗甲状腺良性结节，具有创伤小、恢复快、并发症低的优点，对甲状腺功能无明显影响。

[关键词] 超声下射频消融术；甲状腺手术；甲状腺良性结节；并发症；甲状腺激素

[中图分类号] R653 [文献标识码] B [文章编号] 1673-9701（2017）14-0109-04

[Abstract] Objective To compare the clinical efficacy of ultrasound radiofrequency ablation and thyroid surgery in the treatment of benign thyroid nodules. Methods A total of 67 patients with benign thyroid nodules were divided into the ablation group and the control group. The control group was given thyroidectomy， and the ablation group was given ultrasound radiofrequency ablation. The surgical conditions and complications were compared between the two groups. Six months after the surgery， changes in thyroid-related hormones were measured in both groups. The nodule size was measured 6 months after the surgery in the ablation group. Results The surgery time， intraoperative blood loss， length of stay and surgical scar in the ablation group were significantly lower than those in the control group（P<0.05）； the incidence rate of complications in the ablation group （8.57%） was significantly lower than that in the control group （31.25%）， and the difference was statistically significant （P<0.05）； there were no significant changes in TSH， TT4 and FT3 in the ablation group before the surgery and 6 months after the surgery（P>0.05）； at 6 months after the surgery， TSH was significantly increased in the control group， and TT4 and FT3 were significantly decreased（P<0.05）； at 6 months after the surgery， the differences of TSH， TT4 and FT3 between the two groups were statistically significant（P<0.05）； at 6 months after the surgery， the nodule size in the ablation group was significantly decreased， and the difference was statistically significant（P<0.05）. The reduction rate was （84.36±7.18）%. Conclusion Ultrasound radiofrequency ablation in the treatment of thyroid benign nodules has the advantages of less trauma， quick recovery and low complications， which has no obvious effect on thyroid function.

[Key words] Ultrasound radiofrequency ablation； Thyroid surgery； Benign thyroid nodules； Complications； Thyroid hormone

随着临床超声诊断技术的不断进步，甲状腺良性结节的检出率明显提高。通常甲状腺良性结节无需特殊处理，但由于其存在恶变风险，随着其长大会引起压迫感，影响美观，越来越多的患者选择临床治疗。外科切除术是临床治疗甲状腺良性结节最常用的方式，但手术创伤较大，会留下明显的手术瘢痕，术后并发症较多[1]。随着患者生存质量要求的提高，微创理念逐步成为广大医患临床治疗的主要目标。超声引导下射频消融术属于微创手术，临床广泛用于恶性肿瘤（肝癌、肺癌、肾癌等）的治疗，具有创伤小、恢复快、并发症低等特点，受到了广大医患的青睐[2]。本研究对35例甲状腺良性结节患者采用超声引导下射频消融术治疗，并与常规切除术进行对比分析，探讨其在甲状腺良性结节治疗中的运用价值。……