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

Abstract

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

CLC Number:

R736.1

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.

Figures/Tables 8

Fig. 1

Tab.1

General materials of patients in two groups"

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

Tab.1

Tab.2

Tab.3

Fig. 2

Fig. 3

Tab.4

Tab.5

THYCA-QoL scores of patients in two groups"

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

Tab.5

References 25

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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		-

Comparison of clinical efficacy between microwave ablation and surgical treatment for Hashimoto’s thyroiditis complicated with T1aN0M0 papillary thyroid carcinoma

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