Posterior recurrent laryngeal nerve (RLN) lymph node dissection remains controversial in the operation of thyroid cancer, especially in cases of papillary thyroid microcarcinoma (PTMC). The present study aimed to evaluate the risk factors for posterior RLN lymph node metastasis in patients with PTMC. Two hundred and thirty-nine patients pathologically diagnosed with PTMC after surgery between June 2016 and June 2017 were included. Risk factors including age, sex, tumor diameter, multiple tumor focus, membrane invasion and lateral cervical lymph node metastasis condition, were analyzed, and their corresponding OR values were calculated. The results indicated that posterior RLN lymph node metastasis was pathologically identified in 27/239 patients. Membrane invasion (p = 0.024), VIa lymph node metastasis (p < 0.01), and lateral cervical lymph node metastasis (p < 0.01) were considered to be risk factors for posterior RLN lymph node metastasis. It is concluded that membrane invasion, VIa lymph node metastasis, and lateral cervical lymph node metastasis significantly increased the incidence of posterior RLN lymph node metastasis. Complete dissection of the posterior RLN lymph node was essential for patients with these risk factors.

后喉返神经（RLN）淋巴结清扫在甲状腺癌手术中仍存在争议，特别是在甲状腺微小乳头状癌（PTMC）的情况下。本研究旨在评估PTMC患者后RLN淋巴结转移的危险因素。纳入 2016 年 6 月至 2017 年 6 月手术后病理诊断为 PTMC 的 239 例患者。分析年龄、性别、肿瘤直径、多发灶、膜侵犯及颈外侧淋巴结转移情况等危险因素，计算其对应的OR值。结果表明，在 27/239 名患者中病理发现后部 RLN 淋巴结转移。膜浸润（p = 0.024），VIa淋巴结转移（p < 0.01）和颈外侧淋巴结转移（p < 0.01）被认为是后路RLN淋巴结转移的危险因素。结论是膜侵犯、VIa淋巴结转移和颈外侧淋巴结转移显着增加了后路RLN淋巴结转移的发生率。对于有这些危险因素的患者，彻底清扫 RLN 后部淋巴结至关重要。