热消融治疗甲状腺乳头状癌后喉返神经损伤的影响因素

Impact factors of recurrent laryngeal nerve injury after thermal ablation of papillary thyroid carcinoma

目的观察热消融治疗甲状腺乳头状癌(PTC)后喉返神经损伤的影响因素。方法回顾性分析接受热消融治疗的368例单发PTC患者,以单因素及多因素分析对比有无喉返神经损伤者术前及术中情况,观察喉返神经损伤的影响因素。结果热消融治疗PTC后,27例(27/368,7.34%)出现声音嘶哑(声嘶,即喉返神经损伤),包括18例T1a期、9例T1b+T2期PTC,其间声嘶率差异有统计学意义(χ^(2)=5.15,P=0.02)。热消融后声嘶、无声嘶患者间,PTC T分期,结节与甲状腺前被膜、内侧被膜及后被膜的距离,以及与气管食管沟距离差异均有统计学意义(P均<0.05);多因素分析结果显示,T分期、结节与甲状腺前被膜、与气管食管沟距离及是否注射内侧隔离液为热消融治疗PTC后喉返神经损伤的影响因素(P均<0.05),据此绘制列线图,其预测热消融后喉返神经损伤的C指数为0.88[95%CI(0.82,0.95)]。针对上述差异有统计学意义的计量资料参数和内侧隔离液宽度绘制受试者工作特征曲线,结果显示其预测热消融治疗PTC后喉返神经损伤的效能均较佳。结论PTC T分期,结节与甲状腺前被膜、与气管食管沟的距离,以及是否注射内侧隔离液均为热消融治疗PTC后喉返神经损伤的影响因素。

Objective To observe the impact factors of recurrent laryngeal nerve injury after thermal ablation of papillary thyroid carcinoma(PTC).Methods Data of 368 patients with single PTC lesion who underwent thermal ablation were retrospectively analyzed.The preoperative and intraoperative conditions were compared with single factor and multi factor analysis between patients with or without recurrent laryngeal nerve injury after ablation,respectively,and the impact factors of recurrent laryngeal nerve injury were observed.Results After thermal ablation of PTC,hoarseness which indicating recurrent laryngeal nerve injury occurred in 27 cases(27/368,7.34%),including 18 cases of T1a stage and 9 cases of T1b+T2 stage,and there was significant difference of hoarseness rate between T1a and T1b+T2 stage PTC(χ^(2)=5.15,P=0.02).Significant differences of T stage of PTC,the distance between lesions and anterior,inner,posterior thyroid capsule and tracheoesophageal groove were found between patients with or without hoarseness after ablation(all P<0.05).Multi factor analysis showed that T stage,the distance between thyroid nodule and anterior thyroid capsule and tracheoesophageal groove,as well as injection of medial isolating fluid or not were all impact factors of recurrent laryngeal nerve injury after thermal ablation of PTC(all P<0.05).Then a nomogram was drawn,and the C-index for predicting recurrent laryngeal nerve injury after thermal ablation was 0.88(95%CI[0.82,0.95]).Receiver operating characteristic curve was drawn according to parameters being significant different between patients with or without hoarseness after ablation and the width of injected medial isolating fluid,and the results showed that the efficacy of above parameters for predicting recurrent laryngeal nerve injury after thermal ablation of PTC were all good.Conclusion T stage of PTC,the distance between thyroid nodule and anterior thyroid capsule,between thyroid nodule and tracheoesophageal groove,and injection of medial isolating fluid or not were impact factors of recurrent laryngeal nerve injury after thermal ablation of PTC.