摘要
目的分析行热消融后再治疗的甲状腺大结节患者的临床特征,探讨甲状腺大结节热消融后再治疗的原因。方法2016年1月—2020年12月郑州大学第一附属医院诊治因甲状腺大结节初次行热消融治疗后再治疗患者17例,热消融前行超声引导下细针穿刺(FNA)细胞病理检查,依据甲状腺细胞病理学Bethesda报告系统(TBSRTC)分级判断结节性质。记录患者初次消融至再治疗时间,初次消融前、再消融前FNA细胞病理及手术后组织病理检查结果。初次消融后定期随访行甲状腺超声检查评估结节变化,比较初次消融前与再治疗前(末次随访时)结节最大径、结节成分、血流分级、TI-RADS分级等及促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)水平,计算体积缩小率(VRR)。结果17例患者初次消融前TBSRTC分级均为Ⅱ级,为良性病变;初次消融前结节最大径30~97(46.58±15.81)mm,再治疗前结节最大径31~108(50.94±17.54)mm,VRR-1153%~57%[-9.5%(-92.5%,29.5%)],初次消融至再治疗时间9~62(34.00±11.78)个月;11例消融后行手术治疗,6例消融后再次行消融治疗。11例手术患者中,结节位于左侧5例,右侧6例;4例结节体积缩小,7例结节体积增大;7例术后组织病理结果与初次消融前FNA细胞病理结果一致,2例为恶性潜能未定的滤泡性肿瘤,2例为滤泡癌;初次消融前结节成分多为囊实性(实性为主),血流分级多为1级和2级,TI-RADS分级多为3级;手术患者手术前结节最大径、结节成分、血流分级、TI-RADS分级及TSH、TPOAb水平与初次消融前比较差异均无统计学意义(t=-1.823,χ^(2)<0.001,χ^(2)<0.001,χ^(2)=0.330,t=-0.280,Z=50.500,P均>0.05)。6例再消融患者中,结节位于左侧2例,右侧4例;4例结节体积缩小,2例结节体积增大;6例初次消融前与再消融前FNA细胞病理结果均一致;初次消融前结节成分多为囊实性(实性为主),血流分级多为1级和3级,TI-RADS分级多为3级;再消融患者再消融前结节最大径、结节成分、血流分级、TI-RADS分级及TSH、TPOAb水平与初次消融前比较差异均无统计学意义(t=0.641,χ^(2)=0.051,χ^(2)=1.143,χ^(2)=1.091,t=-1.430,Z=17.000,P均>0.05)。结论结节大小、成分、血流分级及术前病理评估的准确性是影响甲状腺大结节热消融治疗效果的关键因素,应根据患者情况制定个体化治疗方案,以减小热消融后再治疗的风险。
Objective To analyze the clinical characteristics of patients with large thyroid nodules who underwent re-treatment after thermal ablation and to investigate the reasons for re-treatment after thermal ablation.Methods From January 2016 and December 2020,17 patients received re-treatment following initial thermal ablation for large thyroid nodules in the First Affiliated Hospital of Zhengzhou University.Ultrasound-guided fine-needle aspiration(FNA)cytopathological examinations were performed before thermal ablation,and the nature of the nodules was classified according to the Bethesda System for Reporting Thyroid Cytopathology(TBSRTC).The time interval from initial ablation to re-treatment,the cytopathological results of FNA conducted before the initial ablation and re-ablation,and the histopathological results after re-surgery were recorded.After the initial ablation,a regular follow-up with ultrasound examination was conducted to assess the changes in the nodules.The maximum diameter,composition,vascularity grade and TI-RADS classification of the nodules,as well as levels of thyroid-stimulating hormone(TSH)and thyroid peroxidase autoantibodies(TPOAb)before the initial ablation and re-treatment(at the latest follow-up)were compared,and the volume reduction rate(VRR)was calculated.Results All 17 patients had a TBSRTC classification ofⅡbefore the initial ablation,indicating benign lesions.The maximum diameter of the nodules ranged from 30 to 97 mm[(46.58±15.81)mm]before the initial ablation,and from 31 to 108 mm[(50.94±17.54)mm]before re-treatment.The VRR ranged from-1.153%to 57%[-9.5%(-92.5%,29.5%)].The time from initial ablation to re-treatment varied between 9 and 62 months[(34.00±11.78)months].Among these patients,11 underwent surgical treatment following ablation,while 6 underwent ablation.In the 11 patients receiving surgery,the nodules were located on the left side in 5 patients and on the right side in 6.The nodule volume decreased in 4 patients,and increased in 7.The postoperative histopathological results were consistent with the pre-ablation FNA cytopathological results in 7 patients,among whom 2 patients were identified as follicular tumors of indeterminate malignant potential and 2 as follicular carcinoma.The composition of the nodules before initial ablation was predominantly cystic-solid(mainly solid),with vascularity mostly graded at levels 1 and 2,and TI-RADS classified primarily as level 3.The maximum diameter of the nodules,composition,vascularity grade,TI-RADS classification,and levels of TSH and TPOAb showed no significant differences before surgery compared with those before initial ablation(t=-1.823,X^(2)<0.001,X^(2)<0.001,X^(2)=0.330,t=-0.280,Z=50.500;all P values>0.05).Among the 6 patients undergoing re-ablation,the nodules were located on the left side in 2 patients and on the right side in 4.The nodule volume decreased in 4 patients and increased in 2.The FNA cytopathology results were consistent before the initial ablation with those before re-ablation in all 6 cases.The composition of the nodules before initial ablation was predominantly cystic-solid(mainly solid),with vascularity graded mostly at levels 1 and 3,and TI-RADS classified primarily as level 3.The maximum diameter,composition,vascularity grade,TI-RADS classification,and levels of TSH and TPOAb showed no significant differences before re-ablation compared with those before initial ablation(t=0.641,X^(2)=0.051,X^(2)=1.143,X^(2)=1.091,t=-1.430,Z=17.000;all P values>0.05).Conclusions The size,composition,vascularity grade,and accuracy of preoperative pathological assessments are the critical factors influencing the efficacy of thermal ablation on large thyroid nodules.Individualized treatment plan should be devised based on patient-specific conditions to mitigate the risk of re-treatment following thermal ablation.
作者
刘森源
张轶
贺奇
付利军
邱新光
LIU Senyuan;ZHANG Yi;HE Qi;FU Lijun;QIU Xinguang(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)
出处
《中华实用诊断与治疗杂志》
2025年第6期528-533,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省高等学校重点科研项目(22A320048)。
关键词
甲状腺结节
大结节
热消融
再治疗
滤泡性肿瘤
thyroid nodules
large nodules
thermal ablation
re-treatment
follicular carcinoma
