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目的:探讨不同恶性风险分层的甲状腺结节微波消融术后喉返神经(RLN)损伤的独立危险因素。方法:回顾性选取2022年9月至2024年8月在首都医科大学附属北京友谊医院超声科接受甲状腺结节微波消融治疗的240例患者(240个结节)的病历资料,根据美国放射学会甲状腺影像报告和数据系统(TI-RADS)的分类标准和手术记录消融过程中是否发生RLN损伤,对全部病例结节进行分组。TI-RADS 4a及以上的54例RLN损伤患者和65例无RLN损伤患者纳入高风险组;TI-RADS 4a以下的35例RLN损伤患者和86例无RLN损伤患者纳入低风险组。分析结节良恶性,结节上、左右及前后径,以及结节体积、纵横比(>1、≤1)、整体回声、钙化、位置、囊实性和消融参数,进行单因素及多因素分析两组患者RLN损伤的危险因素。结果:两组患者的结节良恶性,结节上、左右及前后径,以及结节体积、纵横比(>1、≤1)、整体回声、钙化、位置和囊实性等指标比较,差异均无统计学意义(P>0.05)。高风险组中结节与气管食管沟距离≤2 mm及结节体积增大是RLN损伤的独立危险因素(OR=4.199、1.002,P<0.05);低风险组中结节位于Z结节上是显著增加RLN损伤风险的危险因素(OR=3.296,P<0.05)。结论:针对不同恶性风险的结节,术前需重点关注解剖位置及体积参数以优化消融方案,降低RLN损伤风险。
Abstract：Objective: To investigate the independent risk factors of recurrent laryngeal nerve(RLN) injury after microwave ablation(MWA) for thyroid nodules of different malignant stratification. Methods: The medical records of 240 patients, who underwent microwave ablation for thyroid nodules in the department of ultrasound, Beijing Friendship Hospital Affiliated to Capital Medical University from September 2022 to August 2024, were retrospectively selected. All thyroid nodule cases were categorized based on the American College of Radiology Thyroid Imaging Reporting and Data System(TI-RADS) classification criteria and whether occurred RLN injury during the ablation procedure. A total of 54 patients with RLN injury and 65 patients without RLN injury, who were classified as TI-RADS 4a or higher than that, were divided into the high-risk group, and 35 patients with RLN injury and 86 patients without RLN injury, who were classified below TI-RADS 4a, were divided into the low-risk group. And then, a series of parameters included the benign and malignant nodules, the upper diameter of nodules, the left and right diameters of nodules, anteroposterior diameters of nodules, the aspect ratio(>1, ≤1), overall echo, calcification, location, cystic solidity, and ablation parameters were analyzed. The risk factors of RLN injury of two groups were analyzed by using single factor and multi factor analysis. Results: There were not significant differences in the benign and malignant nodules, the upper diameters of nodules, the left and right diameters of nodules, anteroposterior diameters of nodules, the volume of nodules, overall echo, calcification, ldiametersocation, and cystic solidity between high and low-risk groups(P>0.05). In high-risk group, the distance between nodules and esophageal groove of trachea was less or equal to 2mm, and the increase of nodule volume were independent risk factors for RLN injury(OR=4.199, 1.002, P<0.05), respectively. In the low-risk group, the nodule, which location was on the Zuckerkandl tubercle(Z-nodule), was risk factor that significantly increased RLN injury(OR=3.296, P<0.05). Conclusion: For nodules with differently malignant risk, the anatomical location, volume parameters and optimized ablation plan should be paid special attention before surgery, so as to reduce the risk of RLN injury.
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基本信息:
DOI：
中图分类号:R581
引用信息:
[1]刘冬,蒲顺帆,胡明阳等.基于甲状腺结节恶性风险分层的微波消融中喉返神经损伤危险因素研究[J].中国医学装备,2025,22(05):1-5.
基金信息:
首都卫生发展科研专项(首发2022-1-2022)~~