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中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 9 -13. doi: 10.3877/cma.j.issn.1674-0793.2022.01.002

论著

微波消融术与甲状腺腺叶切除术对BRAFV600E基因野生型cN0甲状腺微小乳头状癌临床效果对比研究
张娜1,(), 易茂林1   
  1. 1. 438000 湖北省黄冈市中心医院甲乳外科
  • 收稿日期:2021-09-29 出版日期:2022-02-01
  • 通信作者: 张娜
  • 基金资助:
    湖北省卫生健康委员会联合基金项目(WJ2020H130)

Comparative study on the clinical effect of microwave ablation and thyroid lobotomy in BRAFV600E wild-type cN0-PTMC

Na Zhang1,(), Maolin Yi1   

  1. 1. Department of Thyroid and Breast Surgery, Huanggang Central Hospital, Hubei Province, Huanggang 438000, China
  • Received:2021-09-29 Published:2022-02-01
  • Corresponding author: Na Zhang
引用本文:

张娜, 易茂林. 微波消融术与甲状腺腺叶切除术对BRAFV600E基因野生型cN0甲状腺微小乳头状癌临床效果对比研究[J/OL]. 中华普通外科学文献(电子版), 2022, 16(01): 9-13.

Na Zhang, Maolin Yi. Comparative study on the clinical effect of microwave ablation and thyroid lobotomy in BRAFV600E wild-type cN0-PTMC[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(01): 9-13.

目的

探讨微波消融术与甲状腺腺叶切除术对BRAFV600E基因野生型cN0甲状腺微小乳头状癌(PTMC)的临床效果。

方法

选取2017年1月至2019年7月湖北省黄冈市中心医院收治的BRAFV600E基因野生型cN0-PTMC患者108例,采用随机数字表法分为切除组和消融组,每组54例;切除组行甲状腺腺叶切除术,消融组行微波消融术。比较两组围手术期相关指标、甲状腺功能、术后并发症发生情况及随访情况等。

结果

与切除组比较,消融组手术时间、术中出血量、VAS评分、术后住院时间及住院费用显著降低,美观满意度更高(t=27.825、29.693、10.145、15.495、8.152、12.662,均P<0.01)。术后消融组TSH水平较术前显著降低(t=32.457,P<0.001),FT3及FT4水平较术前无显著差异;术后切除组TSH水平较术前显著升高(t=130.517,P<0.001),FT3及FT4水平较术前显著降低(t=28.104、25.641,均P<0.001);术后两组TSH、FT3及FT4水平比较,差异有统计学意义(t=21.022、6.586、4.659,均P<0.001)。消融组术后总并发症发生率为7.4%,显著低于切除组的22.2%,差异有统计学意义(χ2=4.688,P=0.030)。消融组术前与术后各时间点病灶体积比较差异有统计学意义(W=21.052,P<0.001)。随访期间,两组均未发现病灶复发或远处转移病例。

结论

与甲状腺腺叶切除术相比,微波消融术治疗BRAFV600E基因野生型cN0-PTMC不仅具有微创、恢复快、美观满意度高、并发症少等优势,而且能够更好地保留甲状腺功能,且预后良好,具有较高的临床应用价值。

Objective

To investigate the clinical effect of microwave ablation and thyroid lobectomy in small papillary thyroid carcinoma (PTMC) with BRAFV600E gene wild-type cN0.

Methods

A total of 108 patients with BRAFV600E gene wild-type cN0-PTMC admitted to Huanggang Central Hospital from January 2017 to July 2019 were selected and divided into resection group and ablation group by the random number table method, with 54 patients in each group. Thyroid lobectomy was performed in the resection group and microwave ablation was performed in the ablation group. Perioperative indicators, thyroid function, postoperative complications and follow-up were compared between the two groups.

Results

Compared with the resection group, surgical duration, intraoperative blood loss, VAS score, postoperative hospital stay and hospitalization costs were significantly decreased in the ablation group, and aesthetic satisfaction was higher (t=27.825, 29.693, 10.145, 15.495, 8.152, 12.662, all P<0.01). The postoperative TSH level in ablation group was significantly lower than that before surgery (t=32.457, P<0.001), while the FT3 and FT4 levels had no significant difference compared with that before surgery. The level of TSH in resection group was significantly higher than that before surgery (t=130.517, P<0.001), and the level of FT3 and FT4 was significantly lower than that before surgery (t=28.104, 25.641, both P<0.001). There were statistically significant differences in TSH, FT3 and FT4 levels between the two groups after operation (t=21.022, 6.586, 4.659, all P<0.001). The incidence of total postoperative complications in the ablation group was 7.4%, which was significantly lower than that in the resection group (22.2%) (χ2=4.688, P=0.030). There were significant differences in the volume of lesions between the preoperative and postoperative time points in the ablation group (W=21.052, P<0.001). During the follow-up, no recurrence or distant metastasis was found in both groups.

Conclusion

Compared with thyroidectomy, microwave ablation for BRAFV600E gene wild-type cN0-PTMC not only has the advantages of minimally invasion, rapid recovery, high aesthetic satisfaction and less complications, but also can better retain thyroid function, with good prognosis and high clinical application value.

表1 108例BRAFV600E基因野生型cN0-PTMC患者一般资料的比较
表2 108例BRAFV600E基因野生型cN0-PTMC患者围手术期相关指标(±s
表3 108例BRAFV600E基因野生型cN0-PTMC患者甲状腺功能指标(±s
表4 108例BRAFV600E基因野生型cN0-PTMC患者术后并发症[例(%)]
表5 消融组患者术前、术后病灶大小变化情况
[1]
陈小冬. 超声引导下细针穿刺细胞学检查对甲状腺微小癌的诊断价值分析[J]. 中国医药指南, 2019, 17(12): 84-85.
[2]
Xu Y, Xu L, Wang J. Clinical predictors of lymph node metastasis and survival rate in papillary thyroid microcarcinoma: analysis of 3607 patients at a single institution[J]. J Surg Res, 2018, 221: 128-134.
[3]
Brito JP, Hay ID. Management of papillary thyroid microcarcinoma[J]. Endocrinol Metab Clin North Am, 2019, 48(1): 199-213.
[4]
Tunca F, Sormaz İC, İşcan AY, et al. Surgical treatment in papillary thyroid microcarcinoma[J]. Sisli Etfal Hastan Tip Bul, 2018, 52(4): 244-248.
[5]
Ieni A, Vita R, Cardia R, et al. BRAF status in papillary microcarcinomas of the thyroid gland: A brief review[J]. Curr Mol Med, 2019, 19(9): 665-672.
[6]
刘鹏杰,唐铭,邓智勇, 等. BRAFV600E基因突变与甲状腺微小乳头状癌淋巴结转移的相关性研究[J]. 现代肿瘤医学, 2019, 27(4): 552-556.
[7]
Chen B, Zhang Z, Wang K, et al. Association of BRAFV600E mutation with ultrasonographic features and clinicopathologic characteristics of papillary thyroid microcarcinoma: A retrospective study of 116 cases[J]. Clin Hemorheol Microcirc, 2019, 73(4): 545-552.
[8]
Min Y, Wang X, Chen H, et al. Thermal ablation for papillary thyroid microcarcinoma: how far we have come[J]. Cancer Manag Res, 2020, 12: 13369-13379.
[9]
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[10]
程若川,杨婷婷. 2016版中国甲状腺微小乳头状癌诊断与治疗专家共识解读[J]. 中国实用内科杂志, 2019, 39(4): 351-357.
[11]
Xiang T, Yan W, Zhou L. Retrospective analysis of prognostic factors in patients of papillary thyroid microcarcinoma[J]. Oncotarget, 2018, 9( 85): 35553-35558.
[12]
房居高,杨帆. 甲状腺微小乳头状癌规范化诊疗的进展与争议[J]. 中国耳鼻咽喉颅底外科杂志, 2021, 1: 1-5.
[13]
Walgama E, Sacks WL, Ho AS. Papillary thyroid microcarcinoma: optimal management versus overtreatment[J]. Curr Opin Oncol, 2020, 32(1): 1-6.
[14]
Ramundo V, Sponziello M, Falcone R, et al. Low-risk papillary thyroid microcarcinoma: optimal management toward a more conservative approach[J]. J Surg Oncol, 2020, 121(6): 958-963.
[15]
陆晨雅,褚晓秋,陈国芳, 等. 微波消融治疗低危甲状腺微小乳头状癌的临床疗效和病理改变[J]. 国际内分泌代谢杂志, 2021, 41(3): 184-190.
[16]
颜璟,吴艳军,杨映弘, 等. 微波消融与开放手术治疗甲状腺良性结节的比较[J/CD]. 中华普外科手术学杂志(电子版), 2017, 11(6): 525-527.
[17]
Chen BD, Zhang Z, Wang KK, et al. A multivariable model of BRAFV600E and ultrasonographic features for predicting the risk of central lymph node metastasis in cN0 papillary thyroid microcarcinoma[J]. Cancer Manag Res, 2019, 11: 7211-7217.
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