| BackgroundThyroid nodules is one of the most common kind of thyroid diseases,its treatment methods mainly include radioactive I131 therapy,TSH suppression therapy,traditional open surgery,endoscopic surgery and ultrasound-guided minimally invasive treatment.The fifth treatment methods have their own advantages,disadvantages and indications,however ultrasound-guided RFA is less invasive,easy to operate,safe,high cost-effective,precise treatment,good clinical outcome and other advantages,which has already become more popular than other minimally invasive treatment methods in benign thyroid nodules.Now the domestic clinical reports about this method are few,this paper aims to study the clinical treatment value of ultrasound-guided RFA treating benign thyroid nodules,which can provide clinical data support for the standardized and normalized treatment of benign thyroid nodules.ObjectiveThis study aims to comprehensively evaluate the clinical treatment value of RFA in the treatment of benign thyroid nodules and explore the effective preventive measures of complications,by integrated using the technical means(like color Doppler ultrasound,ultrasound angiography,real-time ultrasound elastography),referring the level of thyroid hormone of patients,recording all kinds of complications and combining the beauty scores and symptom scores of patients.MethodsSelected 87 cases of benign thyroid nodules patients who were treated by the ultrasound-guided RFA in The people's Hospital of Changge City between May 2013 andMay 2014,including 23 males and 64 females,aging from 18 to 68 years old whose mean age is(44.25±3.84)years old,114 benign thyroid nodules in total of 74 cases simple nodules and 13 cases multiple nodules which were including 80 solid and 34 cystic and whose diameter of 0.50~4.25,the mean(2.58±1.02)cm.The inclusion criteria: solitary or multiple thyroid nodules,solid or cystic component,benign nodules confirmed by biopsy,the maximum length ?0.5cm and ?5cm,no history of neck surgery and irradiation,normal coagulation and thyroid function,voluntary researchers.Recorded respectively the data like the number,size,borders,perfusion,internal echo,volume,thyroid function,real-time ultrasound elastography,ablation zone,symptom scores,beauty scores of benign thyroid nodules at the time of before surgery,1 month,3months,6 months and 12 months after surgery,and recorded the number of cases of complications before and after surgery.Collected and analyzed the above data,entered it and analyzed it in the SPSS18.0 statistcal software,and undergone the normality test.Skewed distribution data applied the median,measurement data in normality data applied t test,count data used chi-square test,correlation analysis used Logistic regression analysis.The standard of statistically significant difference ?=0.05,P<0.05 showed significant differences,which was statistically meaningful.Test of normality and homogeneity of variance test ?=0.1,P>0.1 showed that the data was consistent with a normal distribution.ResultsThe follow-up time is 1~12(10.23±1.23)months,the lost cases and nodules are 0 case0 nodules,3 cases 5 nodules,6 cases 9 nodules,11 cases 17 nodules of 87 cases of benign thyroid nodules with 114 nodules at the time of 1 month,3 months,6 months and 12 months after RFA.Volume,VRR,RFA effect: With time,the volume of nodules is sequentially(5.64 ±1.02)ml,(3.54 ± 0.87)ml,(2.01 ± 0.67)ml,(0.98 ± 0.32)ml,(0.83 ± 0.25)ml at the time of before RFA,1 month,3 months,6 months,12 months after RFA,the differences are statistically significant(P = 0.000).The VRR is successively(37.23 ± 5.21)%,(64.36 ±7.42)%,(82.62 ± 8.72)%,(85.28 ± 9.03)% at the time of before RFA,1 month,3 months,6months,12 months after RFA,the difference is statistically significant(P = 0.000).At the time of follow-up 6 months,the VRR of 22 nodules is 100%,89 nodules more than 50%,3nodules between 25% to 50%,the cure rate is 19.30%,effective rate is 97.37%,effective rate is 100%,while the complication rate is only 4.60%(4/87).The reduced amplitude of nodule volume during 6 months after RFA(4.66 ± 0.43)ml is bigger than that during 6~12months after RFA(0.15 ± 0.04)ml,the difference is statistically significant(P=0.000);The increased amplitude of nodule VRR during 6 months after RFA(45.39 ± 6.23)% is bigger than that during 6~12 months after RFA(2.66 ± 0.14)%,the difference is statistically significant(P=0.000);Clinical evaluation: With time,the beauty scores are gradually(2.44 ± 0.93),(1.76± 0.82),(1.15 ± 0.77),(0.75 ± 0.32),(0.68 ± 0.23)at the time of before RFA,1 month,3months,6 months,12 months after RFA,the symptom scores also are gradually(4.52 ±1.98)(2.99 ± 1.31)(1.98 ± 1.14)(1.03 ± 0.31)(0.87 ± 0.13),these differences are statistically significant(P = 0.000)at the time of before RFA,1 month,3 months,6 months,12 months after RFA.The reduced amplitude of beauty scores during 6 months after RFA(1.69 ± 0.51)points is bigger than that during 6~12 months after RFA(0.07 ± 0.01)points,the difference is statistically significant(P=0.000);The reduced amplitude of symptom scores during 6 months after RFA(3.49 ± 0.78)points is bigger than that during 6~12months after RFA(0.16 ± 0.03)points,the difference is statistically significant(P=0.000).Ultrasound evaluation: The score of color flow of 114 benign thyroid nodules before ultrasound-guided RFA(2.05 ± 0.87)is significantly higher than that instantly after RFA(0.02 ± 0.01)points,the difference was statistically significant(t = 42.352,P = 0.000);The CEUS score of 114 benign thyroid nodules before ultrasound-guided RFA(2.69 ± 0.58)points is significantly higher than that instantly after RFA(0.09 ± 0.07)points,the difference was statistically significant(t = 42.352,P = 0.000);The residual tumor detection rate of CEUS(7.89%,9/114)is significantly higher than that of the color flow imaging(1.75%,2/114),the difference between groups was statistically significant(X2 = 18.238,P= 0.000).The ablation lesions Flexible rates tended to decrease after RFA treatment,with time,the ultrasound elastography of ablation lesions are(3.32 ± 1.04),(2.56 ± 0.68),(1.44± 0.31),(1.01 ± 0.28)at the time of 1 month,3 months,6 months,12 months after RFA,the differences between groups are all statistically significant(P<0.05).Some correlation exists between ablation lesions ultrasound elastography score and the volume at different follow-up time,and gets higher with time.RFA risk: There are 52 low-risk nodules and 62 high-risk nodules in 114 benign thyroid nodules.The using rate of preventing RFA thermal damage of low-risk nodules(48.08%,25/52)is significantly lower than that of the high-risk nodules(100%,62/62),the difference between groups is statistically significant(X2 = 128.391,P = 0.000);The thermal damage rate of semi-ablation lever method is significantly lower than that of the liquid buffer zone method(23.08%),the difference between groups was statistically significant(P = 0.012).Thyroid function: The thyroid function(FT3,FT4,TSH,TGAb,TPOAb)of all patients are all within the normal reference range before RFA,although the thyroid functions of patients are with a little change at the time of 1 month,3 months,6 months,12 months after RFA,they are all within the normal reference range,the differences are all not statistically significant(P>0.05).Only one case of 87 cases of benign thyroid nodule has a reduced thyroid function after RFA treatment,who self-heal without treatment.Conclusions1.The ultrasound-guided RFA is a minimally invasive treatment of benign thyroid nodules,which is of characters like effective,beautiful,safe,less complications,easy to operate and good controllability.2.The time of 6 months after RFA could be an important time for evaluating the efficacy of ultrasound-guided RFA in the treatment of benign thyroid nodules.3.Both the ultrasound elastography and contrast are effective evaluation methods ofablation effect of RFA in the treatment of benign thyroid nodules.4.Both preoperative ablation risk assessment of thyroid nodules and semi-ablation lever method can be effective in preventing thermal damage during RFA.5.RFA could not produce significant influence to the patient with normal thyroid function during treating benign thyroid nodules,only few people could suffer transient abnormal thyroid function,usually self-heal without special treatment. |
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