Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis
Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis
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DOI：
10.1210/clinem/dgac177
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发表时间：
2022-04-01
影响因子：
5.8
通讯作者：
Yu, Ming-An
中科院分区：
文献类型：
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作者：
Zhao, Zhen-Long;Wei, Ying;Yu, Ming-An
喉返神经（RLN）损伤是热甲状腺结节治疗的并发症。目的探讨甲状腺结节热消融术后喉返神经损伤的影响因素。方法回顾性分析1004例甲状腺结节热消融术患者的临床资料，其中男252例，女752例，中位年龄44岁。将患者分为良性囊性、良性实性和乳头状甲状腺癌（PTC）组。分析与RLN损伤相关的参数，包括结节的最大直径、位置、结节与甲状腺囊和气管食管沟（TEG）的最短距离。进行单因素和多因素分析，以选择喉返神经损伤的危险因素。结果PTC喉返神经损伤率（6.3%）明显高于良性囊性病变（1.2%，P = 0.019）和实性结节（2.9%，P = 0.018）。PTC亚组分析显示T1 b和T2期PTC喉返神经损伤率分别为10.7%和28.6%，均高于T1 a期PTC的5.0%（P < 0.05）。在PTC组中，TEG距离、前囊距离、中囊距离、后囊距离和结节最大直径是RLN损伤的危险因素。逻辑回归拟合的诺模图显示出较高的预测效率（C-Index 0.876）。喉返神经损伤的主要原因是内侧隔离液（MIF）不足。良性囊性、良性实性和PTC结节的MIF安全厚度分别为3.1 mm、3.7 mm和3.9 mm。结论甲状腺结节热消融术前应考虑喉返神经损伤的危险因素。该列线图可预测喉返神经损伤率。
Context Recurrent laryngeal nerve (RLN) injury is a complication of thermal thyroid nodule treatment. Objective We investigated the influencing factors of RLN injury in patients who underwent thermal ablation of thyroid nodules. Methods The data of 1004 patients (252 male, 752 female; median age 44 years) who underwent thermal thyroid nodule ablation were retrospectively reviewed. Patients were divided into benign cystic, benign solid, and papillary thyroid cancer (PTC) groups. The parameters related to RLN injury were analyzed, including the largest diameter, location of the nodules, and shortest distance of the nodule to thyroid capsule and tracheoesophageal groove (TEG). Univariate and multivariate analyses were performed to select risk factors for RLN injury. Results The RLN injury rate was higher in PTC (6.3%) than in benign cystic (1.2%, P = 0.019) and solid nodules (2.9%, P = 0.018). PTC subgroup analysis showed that the RLN injury rate was higher in T1b (10.7%) and T2 (28.6%) PTC than in T1a PTC (5.0%, P < 0.05). In the PTC group, TEG distance, anterior capsule distance, median capsule distance, posterior capsule distance, and maximum nodule diameter were risk factors for RLN injury. The logistic regression fitting of the nomogram showed high prediction efficiency (C-Index 0.876). The main cause of RLN injury was insufficient medial isolating fluid (MIF). The safety thicknesses of MIF for benign cystic, benign solid, and PTC nodules were 3.1 mm, 3.7 mm, and 3.9 mm, respectively. Conclusion Several risk factors for RLN injury should be considered before thermal ablation of thyroid nodules. The RLN injury rate could be predicted with the nomogram.