南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (12): 1694-.

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良性甲状腺囊肿超声引导聚桂醇硬化治疗效果及其相关因素分析

陈志江，王龙，黄怡静，赖水青，陈红梅，裴剑浩，丛淑珍，邝建   

  • 出版日期:2016-12-20 发布日期:2016-12-20

Efficacy of ultrasound-guided lauromacrogol sclerotherapy for benign thyroid cysts and factors affecting the therapeutic effect

  • Online:2016-12-20 Published:2016-12-20

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摘要： 目的分析良性甲状腺囊肿超声引导聚桂醇硬化的治疗效果及其主要影响因素，探讨适合聚桂醇硬化治疗的甲状腺囊肿 类型。方法97例共99个囊腔体积≥2 cm3并经细胞病理诊断为良性的甲状腺囊肿，采用超声引导下聚桂醇硬化治疗，分别在术 后1，3，6，12月进行随访。囊肿按病程、囊液成分、囊液粘稠度、囊实性比例、囊壁厚薄、囊腔分隔进行分类。疗效评价按囊腔体 积缩小<50%为无效，缩小≥50%为有效，缩小≥90%为治愈。结果囊肿基线及治疗后1，3，6，12 月的体积分别为12.08±11.56 cm3、5.63±8.51 cm3、5.96±8.42 cm3、3.80±5.50 cm3、2.85±3.98 cm3；平均囊腔体积缩小（70.0±33.7）%；累积有效率为82.8%（82/ 99），治愈率为63.6%（63/99）；13.1%（13/99）囊肿因1~3个月后较基线增大或无缩小需要再次硬化治疗，病程1年以上的囊肿是 导致多次硬化的独立因素［23.7%（9/38）vs 6.6%（4/61），OR=4.473（1.238~16.169），P=0.022］；治疗效果与囊腔分隔、囊液粘稠 度、囊实性比例、囊壁厚度相关；COX多因素回归分析显示影响囊肿最终疗效（缩小<90%）的主要因素是囊腔分隔（HR=2.25， 95% CI 1.19~4.25）和囊液粘稠（HR=2.02，95% CI 1.19~3.43）。结论超声引导穿刺聚桂醇硬化治疗术可有效安全地治疗良性 甲状腺囊肿，6个月可达到最大治疗效果，对病程1年以下、囊液稀薄、囊腔无分隔的单纯囊肿治疗效果最佳。

Abstract: Objective To evaluate the clinical efficacy of ultrasound-guided lauromacrogol sclerotherapy for benign thyroid cysts and analyze the factors affecting the efficacy. Methods Ultrasound-guided lauromacrogol sclerotherapy was performed in 97 patients with a total of 99 benign thyroid cysts. The changes in cystic volume and other thyroid parameters were evaluated at 1, 3, 6, and 12 months after sclerotherapy. According to changes in the cystic volume, the efficacy of sclerotherapy was defined as therapeutic failure (with a volume reduction <50%), treatment success (volume reduction ≥50%) and cure (volume reduction ≥90%). The factors of affecting the efficacy of sclerotherapy was analyzed using COX regression. Results The mean cystic volume at 1, 3, 6 and 12 months after sclerotherapy were reduced from the baseline volume of 12.08±11.56 cm3 to 5.63±8.51 cm3, 5.96±8.42 cm3, 3.80±5.50 cm3 and 2.85±3.98 cm3, respectively, with an average cystic volume reduction rate of (70.02±33.72)%. Therapeutic success was achieved 82 of the 99 cysts (82.83%) and cure was achieved 63cysts (63.64%) at 12 months after the procedure. A second sclerotherapy was performed for 13 cysts which did not show a volume reduction at 1-3 months after the initial procedure. A disease course of over 12 months was an independent risk factor for a second sclerotherapy (23.7%［9/38］vs 6.6%［4/61］, OR=4.473［1.238-16.169］, P=0.022). The efficacy of sclerotherapy was related to cystic cavity separation, cystic fluid viscosity, cystic/solid ratio and cystic wall thickness. COX regression analysis revealed that cystic cavity separation (HR=2.25, 95%CI: 1.19-4.25) and cystic fluid viscosity (HR=2.02, 95%CI: 1.19-3.43) were the major factors affecting the treatment efficacy. Conclusion Ultrasound-guided lauromacrogol sclerotherapy is effective and safe for treatment of benign thyroid cysts, and the maximal treatment effect can be achieved at 6 months after sclerotherapy and in cases of uncomplicated cysts with non-viscous cystic fluid, no solid cystic cavity separation and a disease course of less than 12 months.