新疆医科大学学报

目的探讨超声引导下无水乙醇硬化治疗(PEI)囊性与囊性为主的甲状腺结节的疗效及影响因素。方法选取2018年1月-2020年12月57例患者共57枚经细胞病理诊断为良性的甲状腺囊肿,采用超声引导下无水乙醇硬化治疗并同时评估患者疼痛感,分别在术后3、6、12个月进行超声随访观察。囊肿按照患者的性别、年龄、初始体积、囊液粘稠度、囊实性比例、血供情况进行分类。疗效评价按囊腔体积缩小<50%为无效,缩50%为有效,缩小≥90%为治愈。结果囊肿治疗前及治疗后3、6、12个月的体积分别为(22.09±22.01)cm³、(5.48±5.94)cm³、(2.90±3.15)cm³、(1.77±2.01)cm³;平均囊腔体积缩小(85.9±14.7)%;累积有效率高达100%,治愈率达66.7%,各次随访囊肿体积与治疗前相比具有统计学差异,不同时间点之间体积缩小率差异均有统计学意义(P<0.001);COX多因素回归分析影响治愈率的主要因素是初始体积大小(HR=3.307,95%CI:1.505～7.262)、囊液粘稠度(HR=3.590,95%CI:1.001～12.869)、囊实性比例(HR=1.882, 95%CI:1.134～3.121)。在PEI期间,70.3%的患者几乎没有疼痛,29.7%轻微疼痛。仅有1例因术后按压不当引起乙醇外渗导致周围组织炎症反应的并发症发生。结论经皮穿刺乙醇无水乙醇硬化治疗甲状腺囊肿是一种有效、安全且耐受性良好的一线治疗方法。对于初始体积小、囊液稀薄、囊性成分比例高的囊肿治疗效果最佳。

Objective To investigate the efficacy and influencing factors of ultrasound-guided percutaneous ethanol injection(PEI) sclerotherapy for cystic and predominantly cystic thyroid nodules. Methods A total of 57 patients with benign thyroid cysts diagnosed by cytopathology from January 2018 to December 2020 were selected and treated with ultrasound-guided PEI sclerotherapy and assessed the pain grading of patients with a series of follow-ups of 3,6 and 12 months postoperatively. Cysts were classified according to patients' gender, age, initial volume, cystic fluid viscosity,cystic solidity ratio, and blood supply. Efficacy evaluation was based on cyst volume, reduction <50% as ineffective, reduction≥50% as effective, and reduction≥90% as curative. Results Cyst volumes at baseline and 3, 6, and 12 months after treatment were(22.09±22.01)cm³,(5.48±5.94)cm³,(2.90±3.15)cm³,(1.77±2.01)cm3,respectively; mean cyst volume reduction was(85.9±14.7) %; cumulative efficiency was up to 100%. Cure rate reached 66.7%, with statistical differences in cyst volume at each follow-up compared with baseline, and statistical differences in volume reduction rates was achieved among each time point(P<0.001); the main factors affecting cure rate by COX multi-factorial regression analysis were initial volume size(HR=3.307, 95% CI:1.505～7.262), cystic fluid viscosity(HR= 3.590, 95% CI:1.001～12.869), and the proportion of cyst solidity(HR=1.882, 95% CI:1.134～3.121). During PEI, 70.3% of patients had little pain and 29.7% had mild pain. Only one complication of inflammatory reaction in the surrounding tissue due to ethanol extravasation caused by improper postoperative compression occurred. Conclusion PEI sclerotherapy is an effective, safe and well-tolerated first-line treatment for symptomatic thyroid cysts. The treatment is more effective in cysts with small initial volume, thin cystic fluid, and a high percentage of cystic components.