沈吉 徐华军 熊伟律

[摘要] 目的 探討超声引导下射频消融（RFA）治疗甲状腺微小乳头状癌（PTMC）的效果，并分析其对患者应激反应的影响。 方法 选取2016年3月～2017年3月在浙江省湖州市中心医院确诊为PTMC患者97例，根据治疗方式不同将所有研究对象分为射频消融组（观察组，n = 45）和微波消融组（对照组，n = 52）。分别于术后第1、3、6、12个月超声随访，观察两组患者病灶体积大小变化，并比较两组患者术后并发症发生率及血清炎性因子[白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）以及C反应蛋白（CRP）]水平的变化。 结果 两组患者术后并发症总发生率比较，差异无统计学意义（P > 0.05），均未出现严重并发症;术后随访期间未见原发灶局部复发或颈部淋巴结转移，超声提示两组患者术后1个月消融灶体积较术前增大，之后消融灶体积逐渐缩小，术后6、12个月，其体积明显缩小，与术前比较差异有统计意义（P < 0.05），各随访时间点两组消融灶体积大小及病灶体积缩小率比较，差异无统计学意义（P > 0.05）;两组患者术后24 h血清IL-6、TNF-α及CRP水平均较术前升高（P < 0.05）;术后72 h血清IL-6、TNF-α及CRP水平基本恢复，与术前比较，差异无统计学意义（P > 0.05）。两组患者术后24 h和72 h血清IL-6、TNF-α及CRP水平比较，差异无统计学意义（P > 0.05）。 结论 超声引导下射频消融是治疗PTMC的一种有效、安全的方法。

[关键词] 甲状腺微小乳头状癌;射频消融;微波消融;应激

[中图分类号] R736.1          [文献标识码] A          [文章编号] 1673-7210（2019）03（a）-0131-05

[Abstract] Objective To investigate the efficacy of ultrasound guided radiofrequency ablation （RFA） in the treatment of papillary thyroid microcarcinoma （PTMC） and to analyze the effect of RFA on the stress response of the patients. Methods From March 2016 to March 2017， 97 patients with PTMC were selected in Huzhou Central Hospital of Zhejiang Province. According to different treatment methods， all subjects were divided into RFA group （observation group， n = 45） and microwave ablation group （control group， n = 52）. Ultrasonic follow up was performed at 1， 3， 6 and 12 months after operation respectively， the lesion foci volume of patients was observed， and the incidence of postoperative complications， the levels of serum inflammatory factors [interleukin -6 （IL-6）， tumor necrosis factor -α （TNF-α） and C reactive protein （CRP）] were compared between the two groups. Results The total incidence complications after operation in the two groups was not statistically significant （P > 0.05）， and no serious complications occurred. No local recurrence or cervical lymph node metastases was found during the follow-up period， ultrasound showed that the volume of ablation in the two groups were increased at 1 month after operation， afterwards， the volume of the ablation range were gradually reduced. The volume decreased significantly at 6 and 12 months after operation， compared with before operation， the difference were statistically significant （P < 0.05）. There was no significant difference in the volume reduction rate and volume of ablation foci between the two groups at each follow-up time point （P > 0.05）. Serum IL-6， TNF-α and CRP levels of the two groups were higher 24 h after surgery than before （P < 0.05）. The levels of serum IL-6， TNF-α and CRP levels recovered basically 72 h after surgery， with no statistically significant difference compared with that before surgery （P > 0.05）. There was no significant difference in the levels of serum IL-6， TNF-α and CRP levels between the two groups 24 h and 72 h after surgery （P > 0.05）. Conclusion Ultrasound guided RFA is an effective and safe method for the treatment of PTMC.

[Key words] Papillary thyroid microcarcinoma; Radiofrequency ablation; Microwave ablation; Stress

甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）是较为常见的甲状腺部恶性肿瘤，其病灶直径≤1.0 cm，近年来高频超声的普及使得越来越多潜在的PTMC患者被发现，临床发病率呈逐年上升趋势[1-3]。虽然PTMC为恶性肿瘤，但是其病程发展缓慢，患者预后一般较好，治疗方案主要取决于肿瘤病灶性质和是否转移，目前临床主张PTMC患者手术切除或随访观察[4-5]。然而，常……