| Objective:The clinical and follow-up data of patients with papillary thyroid microcarcinoma treated by thermal ablation and surgical resection were retrospectively analyzed,and the effectiveness,safety and postoperative quality of life of thermal ablation combined with TSH inhibition compared with surgical resection for papillary thyroid microcarcinoma were discussed.Methods:Data of patients with papillary thyroid microcarcinoma who underwent thermal ablation combined with TSH suppression and surgical resection in the The First Affiliated Hospital of Dalian Medical University from July 2014 to December 2020 were collected and divided into ablation group and resection group.A total of 293 patients were enrolled,including 148 in the ablation group,with an average age of44.80±11.16 years,including 122 females and 26 males.Among them,133 underwent radiofrequency ablation and 15 underwent microwave ablation.There were 145 patients in the resection group,with an average age of 44.18±11.80 years old,including 126 females and 19 males.Among them,68 patients underwent partial thyroidectomy,77 patients underwent total thyroidectomy,and 13 patients underwent routine lymph node dissection in zone VI.Effectiveness indicators:In the ablation group,the results were as follows:(1)Whether the lesion was completely ablation;(2)Ablation volume and reduction rate;(3)Local thyroid recurrence rate;(4)Cervical lymph node metastasis rate.In the resection group,the results were as follows:(1)local thyroid recurrence rate;(2)Cervical lymph node metastasis rateFollow-up dates for both groups ended from November 2022 to January 2023.Safety indicators: intraoperative or postoperative complications such as hoarseness,reduced pitch,choking after drinking water,subcutaneous emphysema,subcutaneous hematoma,parathyroid injury,pain intolerance(requiring drug treatment),postoperative infection and recovery.Quality of life assessment measures: The thyroid cancer-Specific Health Related Quality of Life Scale(THYCA-Qo L)was assessed with 7 dimensional symptoms and 6single items for a total of 24 problems.In addition,the operation time,hospital stay and postoperative incision scar length of the two groups were analyzed.Result:1.Basic clinical data:Among 148 patients in the ablation group,the mean age was 44.80±11.16 years old,including 122 females and 26 males,including 6 Hashimoto’s thyroiditis,6 hypertension,2 diabetes mellitus and 1 cardiovascular disease.The mean follow-up time was41.69±17.59 months,and the longest follow-up time was 98 months.Among 145 patients in the resection group,the mean age was 44.18±11.80 years old,including 126 females and 19 males,including 8 cases of Hashimoto’s thyroiditis,10 cases of hypertension,5 cases of diabetes,and 2 cases of cardiovascular disease.The mean follow-up time was 39.49±18.97 months,and the longest follow-up time was 95 months,with no statistical significance.2.Effectiveness evaluationAfter the ablation,two-dimensional ultrasound showed high echo in the center of the ablation area and low echo in the periphery.There was a clear boundary between the ablation area and the surrounding normal thyroid tissue.Color Doppler ultrasound showed no blood flow in the ablation area.Contrast-enhanced ultrasound showed that no contrast agent perfusion was observed in the ablation area of all patients,and the unperfused area completely covered and exceeded the lesion range,and the success rate of one ablation was 100%.The longest follow-up time of the ablation group was 98 months,and the mean follow-up time was 41.69±17.59 months.The longest follow-up time of the resection group was 95 months,and the mean follow-up time was 39.49±18.97 months.During the follow-up,the lesion volume decreased significantly in the ablation group,and the lesion shrinkage rate at 1,3,6,9 and 12 months after surgery was(44.57±22.54)%,(73.10±17.76)%,(88.59±13.11)%,(95.42±7.61)%,(98.44±4.67)%,respectively.At18 months,all ablation areas were completely absorbed,and the reduction rate of lesion volume reached 100%.All patients in both groups were treated with Unimethylate for TSH inhibition after surgery.During the follow-up,2 patients in the ablation group had relapse without cervical lymph node metastasis.In the resection group,there were 2cases with cervical lymph node metastasis without recurrence,and the differences were not statistically significant.3.Safety evaluationPostoperative hoarseness occurred in 1 case in the ablation group,which returned to normal 30 min later,and no recurrent laryngeal nerve injury,parathyroid injury,postoperative infection and other serious complications occurred.There were 16 cases of complications in the resection group,and the complication rate in the resection group was significantly higher than that in the ablation group(11.03% vs 0.67%),with statistical significance(P<0.01).4.Postoperative quality of life assessmentThe mean QOL score of the ablation group was 103.21±41.62,and that of the excision group was 149.48±70.51.Among them,sound problems(P=0.012),psychological problems(P=0.006)and scar problems(P<0.001)were significantly higher in the resection group than in the ablation group,and the difference was statistically significant.5.OthersThe operative time of ablation group was less than that of excision group(7.51±1.77 min vs 130.59± 34.79 min,P<0.01),and the hospital stay of ablation group was less than that of excision group(1.00± 0.00 d vs 7.86± 3.79 d,P<0.01),and the differences were statistically significant.There was no significant postoperative scar in the ablation group,and the mean postoperative scar length in the resection group was 5.07±1.76 cm,with statistical significance(P<0.01).Conclusion:1.Both thermal ablation combined with TSH suppression and surgical resection are effective and safe in the treatment of PTMCS,and thermal ablation combined with TSH suppression is expected to be an alternative choice for resection of PTMCS.2.Ultrasound-guided thermal ablation combined with TSH inhibition is shorter than surgical resection and hospital stay,and more aesthetically attractive after surgery,with unique advantages in improving patients’ postoperative quality of life. |
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