甲状腺微小乳头状癌侵犯喉返神经的特点及危险因素分析

Characteristics and risk facters of papillary thyroid microcarcinoma invading recurrent laryngeal nerve

目的探讨甲状腺微小乳头状癌侵犯喉返神经的临床病理特征及危险因素。方法回顾性2015年1月到2016年7月间郑州大学第一附属医院确诊的10例甲状腺微小乳头状癌侵犯喉返神经的资料,1∶1匹配的对照组。采用单因素、多因素非条件logistic回归模型甲状腺微小乳头状癌侵犯喉返神经的危险因素。结果甲状腺微小乳头状癌侵犯喉返神经病例中年龄大于45岁、女性、侵犯部位多发生于右侧,BRAFv600基因突变多见,但术前声音嘶哑症状、喉镜声带麻痹并不多见。Logistic回归模型中结果显示肿瘤结节低血流信号与喉返神经侵犯存在正相关(OR=13.5,95%CI:1.198~142.9)。结论甲状腺微小乳头状癌侵犯喉返神经与甲状腺微小乳头状癌向血供生长及喉返神经在Berry韧带及入喉区的血供解剖密切相关。近后包膜的低血流信号的微小乳头状癌术前应更充分考虑其侵犯喉返神经的可能性。

Objective To investigate the characteristics and the risk factors of papillary thyroid microcarcinoma invading the recurrent laryngeal nerve. Methods Totally 10 patients with papillary thyroid microcarcinoma invading the recurrent laryngeal nerve,who were received the surgery and diagnosed in the First Affiliated Hospital of Zhengzhou University from January 2015 to July 2016 were included in this study. A 1∶1 matched case control study was carried out. Univariate and multivariate Logistic regression were used to analyze the risk factors. Results The characteristics of papillary thyroid carcinoma invasion recurrent laryngeal nerve： age 〉 45 years old,female,in right lobe,multiple,BRAFv600 gene mutation. Meanwhile,the symptom of hoarseness or vocal cord paralysis was rare. Logistic regression model showed that there was a positive correlation between the lower level of blood flow of tumor nodules and recurrent laryngeal nerve invasion（ OR = 13. 5,95% CI： 1. 198 ~ 142. 9）. Conclusion Papillary thyroid microcarcinoma invading the recurrent laryngeal nerve was closely related to the growth tendency of papillary thyroid microcarcinoma toward better blood supply. The anatomy and blood supply around recurrent laryngeal nerve might also play an importment role. The possibility of invasion should be deliberately assessed before surgery for papillary thyroid microcarcinoma,which was near the recurrent laryngeal nerve invasion with lower level blood flow.