目的

探讨射频消融术（RFA）联合促甲状腺激素（TSH）抑制治疗甲状腺微小乳头状癌（PTMC）的效果及生存预后。

方法

回顾性分析2020年4月至2023年4月收治的148例PTMC患者病例资料，按照治疗方式不同分为RFA组（行RFA联合TSH抑制治疗，n=76例）和切除组（行外科切除术联合TSH抑制治疗，n=72例）。数据用SPSS 24.0软件分析，手术相关指标、病灶体积、甲状腺激素指标等计量资料用（x±s）表示，组间比较采用LSD-t检验，组内比较采用配对样本t检验；淋巴结转移率、肿瘤复发率等计数资料用［例（%）］表示，采用χ²检验。P＜0.05为差异有统计学意义。

结果

RFA组患者手术时间、术中失血量、住院时间、VSS评分均低于切除组（P＜0.05）。RFA组患者并发症发生率低于切除组（P＜0.05）。术后1、3、6、12个月，RFA组患者病灶体积均呈降低趋势、病灶体积缩小率（VRR）均呈升高趋势（P＜0.05）。术后30d，RFA组患者TSH水平降低（P＜0.05），且RFA组低于切除组（P＜0.05）；术后30d，两组游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）均降低（P＜0.05），但RFA组高于切除组（P＜0.05）。两组患者总不良预后发生率比较（1.3% vs.4.2%）无显著差异（P＞0.05）。

结论

RFA结合TSH抑制治疗与外科切除均可获取良好疗效，但RFA术式可降低术中失血量、手术及住院时间，避免高并发症风险，促进病灶尽快吸收，且远期预后效果更佳，更具微创优势。

Objective

To investigate the effect and survival prognosis of radiofrequency ablation(RFA) combined with thyroid stimulating hormone (TSH) suppression in the treatment of papillary thyroid microcarcinoma (PTMC).

Methods

The medical records of 148 patients with PTMC in the hospital were retrospectively analyzed from April 2020 to April 2023.According to different treatment methods, they were divided into RFA group (RFA combined with TSH suppression therapy, n=76) and resection group (surgical resection combined with TSH suppression therapy, n=72).The data were analyzed by SPSS 24.0 software.Measurement data such as surgical related indicators, lesion volume and thyroid hormone indicators were expressed as (x±s).LSD-t test was used for between-group comparison, and paired sample t test was adopted for within-group comparison.Enumeration data such as lymph node metastasis rate and tumor recurrence rate were expressed as ［cases (%)］ by adopting χ² test.P＜0.05 was considered statistically significant.

Results

The surgical time, intraoperative blood loss, hospital stay and VSS score in RFA group were shorter or less than those in resection group (P＜0.05).The incidence rates of complications in RFA group were lower than those in resection group (P＜0.05).At 1, 3, 6 and 12 months after surgery, the lesion volume in RFA group showed a decreasing trend, and the VRR showed an increasing trend (P＜0.05).TSH level at 30 days after surgery was increased in RFA group (P＜0.05), and the level was lower in RFA group than that in resection group (P＜0.05).The levels of free triiodothyronine (FT3) and free thyroxine (FT4) at 30 days after surgery were declined in both groups (P＜0.05), but the levels in RFA group were higher than those in resection group (P＜0.05).There was no obvious difference in incidence rate of total poor prognosis between both groups (1.3% vs. 4.2%)(P＞0.05).

Conclusion

RFA combined with TSH suppression therapy and surgical resection can achieve good results, but RFA can better reduce intraoperative blood loss, surgical time and hospital stay, avoid high risk of complications and promote rapid absorption of lesions, and it has better long-term prognosis effect and has more minimally invasive advantages.