甲状腺乳头状癌侵犯后被膜与喉返神经受侵的相关因素分析

The correlation between recurrent laryngeal nerve invasion and papillary thyroid carcinoma with posterior capsular involvment

目的探讨甲状腺乳头状癌侵犯后被膜时喉返神经受侵的相关因素。方法回顾性分析2017年6月至2022年6月秦皇岛市第一医院收治的186例甲状腺乳头状癌患者的临床资料, 包括患者性别、年龄、肿瘤大小、是否合并桥本甲状腺炎、中央区淋巴结是否转移、颈侧区淋巴结是否转移以及BRAFV600E基因是否阳性。观察甲状腺手术中喉返神经受侵情况, 对数据进行单因素分析及多因素回归分析。结果 186例患者中喉返神经受侵30例。单因素分析显示喉返神经受侵与肿瘤大小、是否合并桥本甲状腺炎及颈侧区淋巴结是否转移有关(χ^(2)=6.964、4.814、6.078, 均P<0.05)。多因素回归分析显示, 肿瘤大小、颈侧区淋巴结是否转移是喉返神经受侵的独立危险因素(β=1.020、1.622, P<0.05), 合并桥本甲状腺炎是喉返神经受侵的保护因素(β=-1.881, P<0.05)。结论甲状腺乳头状癌侵犯后被膜时, 肿瘤较大、伴有颈侧区淋巴结转移提示喉返神经受侵的风险较高, 而合并桥本甲状腺炎则提示喉返神经更不易受侵。

Objective To investigate the factors related to recurrent laryngeal nerve invasion in papillary thyroid carcinoma(PTC)with posterior capsular involvment.Methods The data of 186 PTC patients admitted and operated from Jun 2017 to Jun 2022 were retrospectively analyzed.The invasion of recurrent laryngeal nerve was evaluated on its relation to gender,age,tumor size,Hashimoto's thyroiditis,lymph node metastasis in central region,BRAFV600E gene mutation especially PTC posterior capsular involvement.Results The recurrent laryngeal nerve was invaded in 30 out of 186 patients.Univariate analysis showed that recurrent laryngeal nerve invasion was related to tumor size,Hashimoto's thyroiditis and cervical lymph node metastasis(χ2=6.964,4.814,6.078,P<0.05).Multivariate regression analysis showed that tumor size and lymph node metastasis in cervical region were independent risk factors for recurrent laryngeal nerve invasion(β=1.020,1.622,P<0.05).Hashimoto's thyroiditis was a protective factor for recurrent laryngeal nerve invasion(β=-1.881,P<0.05).Conclusions When papillary thyroid carcinoma invaded the capsule,the risk of recurrent laryngeal nerve invasion was higher with larger tumor size and cervical lymph node metastasis,while Hashimoto's thyroiditis was a protective factor for the risk of recurrent nerve invasion.