摘要
目的探讨不同体积结节在微波消融过程中导致喉返神经(recurrent laryngeal nerve,RLN)损伤的独立危险因素,为临床风险分层提供依据。方法回顾性分析2022年9月至2024年8月接受微波消融治疗并发生喉返神经损伤的患者,根据结节体积分为大结节组(≥500 mm 3)和小结节组(<500 mm 3),每组按12匹配无RLN损伤病例。收集4类22项参数,通过单因素及多因素logistic回归分析筛选危险因素,并构建预测模型。结果大结节组(34例损伤/82例对照)中,Z结位置(OR=3.418,95%CI:1.326~8.809)、实性结构(OR=2.795,95%CI:1.066~7.360)及前被膜间距>2 mm(OR=5.097,95%CI:1.508~17.232)为喉返神经损伤的独立危险因素。小结节组(40例损伤/104例对照)中,较高的消融功率(OR=0.904,95%CI:0.828~0.986)是喉返神经损伤的独立保护因素,结节与气管食管沟(tracheoesophagealgroove,TEG)间距≤2 mm(OR=5.717,95%CI:2.402~13.605)为喉返神经损伤的独立危险因素。结论大结节RLN损伤风险与解剖位置及结节囊实性相关,而小结节风险受能量参数及邻近神经距离影响。分层评估可优化个体化消融策略。
Objective To investigate the independent risk factors for recurrent laryngeal nerve(RLN)injury during microwave ablation of thyroid nodules with different volumes,and to provide evidence for clinical risk stratification.Methods Patients who underwent microwave ablation between September 2022 and August 2024 and developed RLN injury were retrospectively included in the study.Nodules were stratified into large(≥500 mm 3)and small(<500 mm 3)volume groups.Each case was 12 matched with controls(no RLN injury).Four categories of 22 parameters were collected,and univariate/multivariate Logistic regression analyses were performed to identify risk factors and construct predictive models.Results In the large nodules group(34 cases of injury/82 cases of control),Z-node location(OR=3.418,95%CI:1.326-8.809),solid structure(OR=2.795,95%CI:1.066-7.360)and anterior capsule distance>2 mm(OR=5.097,95%CI:1.508-17.232)were independent risk factors or recurrent laryngeal nerve injury.In the small nodules group(40 cases of injury/104 cases of control),higher ablation power(OR=0.904,95%CI:0.828-0.986)was an independent protective factor for recurrent laryngeal nerve injury,and TEG spacing≤2 mm(OR=5.717,95%CI:2.402-13.605)was an independent risk factor for recurrent laryngeal nerve injury.Conclusions RLN injury risk in large nodules correlates with anatomical location and solid-cystic composition,while small-nodule risk is influenced by energy parameters and proximity to adjacent nerves.Volume-stratified assessment optimizes personalized ablation strategies.
作者
刘冬
胡明阳
蒲顺帆
王亚文
钱林学
Liu Dong;Hu Mingyang;Pu Shunfan;Wang Yawen;Qian Linxue(Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中国医学前沿杂志(电子版)》
北大核心
2025年第6期40-46,共7页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
首都卫生发展科研专项项目(首发重点攻关2022-1-2022)。
关键词
甲状腺结节
微波消融
喉返神经
分层
Thyroid nodule
Microwave ablation
Recurrent laryngeal nerve
Stratification
