中国现代手术学杂志2025，Vol.29Issue(2)：92-99,8.DOI:10.16260/j.cnki.1009-2188.2025.02.002
微波消融治疗甲状腺结节的疗效观察及并发喉返神经损伤的危险因素分析
The therapeutic effect of microwave ablation therapy on thyroid nodules and risk factors for postopera-tive recurrent laryngeal nerve injury
摘要
Abstract
Objective To explore the therapeutic effect of microwave ablation(MWA)therapy on thyroid nodules and the risk factors for postoperative recurrent laryngeal nerve(RLN)injury.Methods 358 patients with thyroid nodules admitted to our hospital from July 2022 to January 2024 were selected for MWA treatment.They were followed up for 6 months after surgery to evaluate the efficacy of MWA treatment in resolving thyroid problems.Based on the follow-up results of RLN,they were divided into an injured group and an uninjured group,and general information and surgical indicators of all patients were collected.Logistic regression analysis was used to identify the influencing factors of RLN injury in thyroid nodules after MWA treatment.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of RLN injury in thyroid nod-ules after MWA treatment.RStudio 4.2.1 was used to construct the nomogram,the accuracy of which was eval-uated through internal and external validation.Results Out of 358 patients,323 were determined to have successfully undergone ablation,with an average volume reduction ratio(VRR)of 78.65％±15.33％and a treatment success rate(VRR＞50％)of 90.22％.The follow up results showed a total of 16 patients developed RLN injury,with an incidence rate of 4.47％.342 patients(95.53％)recovered well after surgery.According to the follow-up results,they were divided into an injured group of 16 cases(group A)and an uninjured group of 342 cases(group B).In group A,patients had older age,larger nodule volume,longer ablation time and higher ablation frequency than those of group B(P＜0.05).Logistic regression analysis showed that age(OR=1.545,95％CI=1.180～2.023),ablation time(OR=1.336,95％CI=1.147～1.558),ablation frequency(OR=32.084,95％CI=3.731～275.921),and nodule volume(OR=2.135,95％CI=1.417～3.217)were independent risk factors for RLN injury after MWA treatment.ROC analysis showed that the AUC of their com-bined detection of RLN injury was 0.975,which was higher than that of single detection.The sensitivity and specificity was 93.75％and 90.64％respectively.358 cases were split into a training set with 250 cases and a validation set with 108 cases.The AUC(95％CI)of the ROC in the training and validation set was 0.99(0.97～1.00)and 0.94(0.85～1.00)respectively.Bootstrap method was sampled 1 000 times,and the calibration curve was close to the ideal curve(P=0.999,0.258).The decision curve showed that this predic-tive model could provide the additional clinical net benefit in the aspect of predicting the risk of RLN injury in MWA treatment when the risk threshold value was 5％～80％.Conclusions MWA treatment has significant therapeutic effects on thyroid nodules.Age,ablation time,ablation frequency,and nodule volume are its independent risk factors for RLN injury.The nomogram model based on these factors has good predictive performance,which helps clinical doctors evaluate the risk of RLN injury occurrence and has certain clinical application value.关键词
甲状腺结节/微波消融/喉返神经损伤/危险因素/预测模型Key words
thyroid nodules/microwave ablation/recurrent laryngeal nerve injury/risk factors/prediction model引用本文复制引用
聂晖,吴慧娟,孔运生,叶显俊..微波消融治疗甲状腺结节的疗效观察及并发喉返神经损伤的危险因素分析[J].中国现代手术学杂志,2025,29(2):92-99,8.基金项目
2022年国家卫生健康委医疗质量循证管理持续改进研究项目(YLZLXZ22G025) （YLZLXZ22G025）
