良性甲状腺结节微创治疗并发症的预防与管理策略：系统综述
该研究系统综述了超声引导热消融治疗良性甲状腺结节的并发症发生率、预防和管理策略。纳入11项研究共15,333例患者，总体并发症率为4.3%，主要并发症罕见（0.16%），术后疼痛最常见（1.5%）。预防依赖操作者培训、颈部解剖知识、水隔离技术、经峡部入路和移动消融技术。
要点
- 热消融治疗良性甲状腺结节总体并发症率4.3%，主要并发症仅0.16%。
- 术后疼痛最常见，发生率1.5%，多数为轻微自限性。
- 水隔离、经峡部入路和移动消融技术是预防并发症的关键。
诊断标准与关键数值
- 总体并发症合并发生率为4.3%（范围1.0-8.8%）。
- 术后疼痛最常见，发生率为1.5%（范围0-5%）。
- 主要并发症发生率为0.16%，轻微并发症发生率为4.2%。
临床应用与阅片要点
- 术前应充分掌握颈部解剖，尤其是喉返神经、气管、食管和血管与甲状腺的毗邻关系。
- 术中常规使用水隔离技术分离甲状腺与周围危险结构，降低热损伤风险。
- 采用经峡部入路和移动消融技术，避免热量集中导致并发症。
- 术后疼痛多为轻微，但需与出血、神经损伤等主要并发症鉴别。
局限性
- 证据质量低，偏倚风险为中等至严重。
- 纳入研究间并发症报告标准可能不一致。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: Ultrasound (US)-guided thermal ablation (TA) is widely used as a minimally invasive alternative to surgery for symptomatic benign thyroid nodules. Although less invasive, complications occur in up to 4% of cases. This review assessed the incidence of TA-related complications, focusing on prevention and management.
MATERIAL AND METHODS: PubMed, Embase, and Cochrane were searched for studies on thyroid TA complications. Eligible studies were in English, included > 100 patients, reported complication rates, and had full text available. Studies with malignant nodules, unclear reporting, or < 100 patients were excluded. Risk of bias was assessed with ROBINS-I and evidence certainty with GRADE. Complications and preventive strategies were summarized.
RESULTS: Among 282 screened studies, 11 including 15,333 patients were analyzed. The pooled overall complication rate was 4.3% (range 1.0-8.8%). Post-procedural pain was most common (1.5%, range 0-5%). Major complications were rare (0.16%), while minor complications occurred in 4.2%. Prevention relied on operator training, knowledge of neck anatomy, hydrodissection, trans-isthmic approach, and moving-shot technique.
CONCLUSIONS: Thyroid TA is safe, with very low major complication rates, though minor events may occur. Best results require strong anatomical knowledge, ultrasound expertise, and correct technique. Evidence quality remains low with moderate-to-serious risk of bias.
引用
- Mauri G, Monfardini L, Glielmo P, et al. Complications of minimally invasive treatments of benign thyroid nodules: preventive andmanaging strategies: A systematic review. Radiol Med. 2026. PMID: 42213383. doi:10.1007/s11547-026-02220-1
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。