微波消融与外科手术治疗桥本甲状腺炎并发T1aN0M0期甲状腺乳头状癌的临床疗效比较

doi:10.13481/j.1671-587X.20250620

摘要/Abstract

摘要：

目的探讨微波消融（MWA）与外科手术治疗桥本甲状腺炎（HT）并发T1aN0M0期甲状腺乳头状癌（PTC）的临床疗效，阐明MWA作为微创治疗手段的可行性和优势。方法采用回顾性队列研究方法，选取2018年1月—2020年12月确诊为HT并发T1aN0M0期PTC的患者165例，分为MWA组（82例）和外科手术组（83例）。MWA组患者在超声引导下进行MWA治疗，外科手术组患者接受甲状腺单侧叶切除术+单侧淋巴结清扫术。中位随访时间为（65.98 $±$ 7.32）个月，记录并分析2组患者年龄、术前肿瘤体积、手术时间、术中出血量、住院时间、住院费用、肿瘤进展、术后并发症发生率、甲状腺功能变化、肿瘤复发率及患者生活质量评分等指标。结果 2组患者年龄、性别和术前肿瘤体积、边缘、形状、纵横比、钙化及甲状腺功能等基线样本资料比较差异均无统计学意义（P $>$ 0.05）。与外科手术组比较，MWA组患者手术时间、术中出血量、住院时间及住院费用差异有统计学意义（P $<$ 0.01），术后并发症发生率差异无统计学意义（P $>$ 0.05）。MWA组患者所有结节在18个月内实现完全消融，术后功能性甲状腺实质保留良好，随访期间甲状腺功能均维持在正常生理范围。甲状腺癌特异性生活质量量表（THYCA-QoL）评分，与MWA组比较，外科手术组患者声音、交感神经症状、咽喉/口腔问题、心理、感觉问题、瘢痕和畏寒6个维度评分明显升高（P $<$ 0.05）。2组患者肿瘤进展率比较差异无统计学意义（P $>$ 0.05）。结论在中位随访期间，MWA和外科手术治疗HT并发T1aN0M0期PTC患者均取得了较为满意的临床疗效。MWA治疗在手术时间、术中出血量、住院时间、住院费用、生活质量和甲状腺功能保留等方面具有明显优势，可作为此类患者的微创治疗选择，但其远期肿瘤学安全性需延长随访进一步评估。

关键词: 桥本甲状腺炎, 甲状腺乳头状癌, 微波消融, 外科手术, 临床疗效, 微创治疗

Abstract:

Objective To discuss the clinical efficacy of microwave ablation （MWA） and surgical treatment in the patients with Hashimoto thyroiditis （HT） complicated with T1aN0M0 stage papillary thyroid carcinoma （PTC）， and to clarify the feasibility and advantages of MWA as a minimally invasive treatment modality. Methods A retrospective cohort study was used. A total of 165 patients diagnosed with HT complicated with T1aN0M0 stage PTC from January 2018 to December 2020 were selected and divided into MWA group （82 cases） and surgery group （83 cases）. The patients in MWA group underwent MWA treatment under ultrasound guidance， and the patients in surgery group underwent unilateral thyroid lobectomy + unilateral lymph node dissection. The median follow-up time was （65.98±7.32） months. The indicators such as age， preoperative tumor volume， operation time， intraoperative blood loss， hospital stay， hospitalization cost， tumor progression， incidence of postoperative complications， changes in thyroid function， tumor recurrence rate， and life quality score of the patients in two groups were recorded and analyzed. Results There were no significant differences in the baseline sample data including age， gender， preoperative tumor volume， margin， shape， aspect ratio， calcification， and preoperative thyroid function between two groups （P>0.05）. Compared with surgery group， the operation time， intraoperative blood loss， hospital stay， and hospitalization cost of the patients in MWA group were significantly decreased （P<0.01）， and there was no significant difference in the incidence of postoperative complications （P>0.05）. All nodules in the patients in MWA group achieved complete ablation within 18 months. The functional thyroid parenchyma in the patients in MWA group was well preserved after operation， and the thyroid function was maintained within the normal physiological range during the follow-up period. The Thyroid Cancer-specific Quality of Life Questionnaire（THYCA-QoL） results showed that compared with MWA group， the scores of voice， sympathetic nerve symptoms， throat/mouth problems， psychological， sensory problems， scar， and chills of the patients in surgery group were significantly inecreased （P<0.05）. There was no significant difference in the tumor progression rate between two groups （P>0.05）. Conclusion During the median follow-up period， both MWA and surgical treatment achieve satisfactory clinical efficacy in the patients with HT complicated with T1aN0M0 stage PTC. MWA treatment has significant advantages in operation time， intraoperative blood loss， hospital stay， hospitalization cost， quality of life， and preservation of thyroid function， and it can be used as a minimally invasive treatment option for such patients， but its long-term oncological safety needs to be further evaluated by extending the follow-up.

Key words: Hashimoto thyroiditis, Papillary thyroid carcinoma, Microwave ablation, Surgery, Clinical efficacy, Minimally invasive treatment

中图分类号:

R736.1

徐艺璇,王辉. 微波消融与外科手术治疗桥本甲状腺炎并发T1aN0M0期甲状腺乳头状癌的临床疗效比较[J]. 吉林大学学报(医学版), 2025, 51(6): 1646-1654.

Yixuan XU,Hui WANG. Comparison of clinical efficacy between microwave ablation and surgical treatment for Hashimoto’s thyroiditis complicated with T1aN0M0 papillary thyroid carcinoma[J]. Journal of Jilin University(Medicine Edition), 2025, 51(6): 1646-1654.

图/表 8

图1

表1

2组患者一般资料"

Group	n	Age(x±s, year)	Gender [n/(η/%)]		Median follow-up(x±s, month)
Group	n	Age(x±s, year)	Male	Female	Median follow-up(x±s, month)
MWA	82	44.90 $±$ 9.16	9(11.0)	73(89.0)	65.62 $±$ 7.31
Surgery	83	42.27 $±$ 8.54	6(7.2)	77(92.8)	66.45 $±$ 7.44
P		0.057	0.431		0.472

表1

表2

表3

图2

图3

表4

表5

2组患者THYCA-QoL评分 (xˉ±s)"

Group	n	Neuromuscular	Voice		Concentration	Sympathetic	Throat/mouth problems		Psychological	Sensory
MWA	82	1.03 $±$ 0.12	1.02 $±$ 0.11		1.01 $±$ 0.05	1.00 $±$ 0.00	1.01 $±$ 0.05		1.05 $±$ 0.15	1.04 $±$ 0.13
Surgery	83	1.07 $±$ 0.17	1.14 $±$ 0.22		1.02 $±$ 0.11	1.17 $±$ 0.29	1.07 $±$ 0.14		1.12 $±$ 0.18	1.17 $±$ 0.29
P		0.087	<0.01		0.179	<0.01	<0.01		0.013	<0.01
Group	n	Problems with scar	Felt chilly	Tingling hands/feet		Gained weight	Headache	Less interest in sex		Total
MWA	82	1.00 $±$ 0.00	1.02 $±$ 0.15	1.00 $±$ 0.00		1.01 $±$ 0.11	1.01 $±$ 0.11	1.04 $±$ 0.19		13.24 $±$ 0.50
Surgery	83	1.27 $±$ 0.44	1.04 $±$ 0.18	1.02 $±$ 0.15		1.06 $±$ 0.24	1.05 $±$ 0.22	1.07 $±$ 0.26		14.27 $±$ 1.21
P		<0.01	0.662	0.159		0.100	0.179	0.315		<0.01

表5

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Time（month）	Volume (V/cm³)		VRR (η/%)
Time（month）	Mean Range		Mean Range
1	0.59±0.36	0.51-0.66	22.27±75.31	5.72-38.82
3	0.35±0.26	0.29-0.21	49.83±78.19	32.65-67.01
6	0.06±0.07	0.04-0.07	94.03±7.58	92.36-95.70
12	0.02±0.03	0.01-0.02	98.49±2.70	97.89-99.08
18	0.00±0.00	0.00-0.00	1.00±0.00	100.00-100.00

Group	n	New lession		Lymphnode metastasis		Distant metastasis
Group	n	Recurrence	No recurrence	Metastasis	No metastasis	Metastasis	No metastasis
MWA	82	2（2.4）	80（97.6）	1（1.2）	81（98.8）	0(0.0)	82（100.0）
Surgery	83	0（0.0）	83（100.0）	0(0.0)	83（100.0）	0(0.0)	83（100.0）
P		0.245		0.497		-