显露喉返神经在甲状腺切除中的临床意义

目的探讨显露喉返神经在甲状腺手术中的临床意义。方法回顾性分析2007年4月至2009年10月本院827例甲状腺手术患者的临床资料,根据术中是否显露喉返神经分为显露喉返神经组和非显露喉返神经组。结果显露喉返神经组475例,喉返神经损伤4例,损伤率0.84%;非显露喉返神经组352例,喉返神经损伤17例,损伤率4.83%。两组比较差异有统计学意义(P0.05)。结论甲状腺切除术中显露喉返神经对保护喉返神经是安全和有效的。     

甲状腺再次手术中喉返神经实时监测与常规显露临床对比研究

目的 比较甲状腺再次手术中喉返神经实时监测与常规显露的差异,探讨术中喉返神经监测在甲状腺再次手术中应用的临床价值。 方法 回顾性分析2014年5月至2016年5月于哈尔滨医科大学附属第一医院甲状腺乳腺外科接受甲状腺再次手术118例病人资料。其中应用术中喉返神经监测联合肉眼识别保护且术前电子喉镜检查正常者45例（神经监测组）,采用随机数表法,按照1：1对照原则,选取常规显露保护喉返神经且术前电子喉镜检查正常者45例为对照组（常规显露组）。比较分析两组病人在喉返神经识别率、确认识别时间、术后暂时性喉返神经损伤、永久性喉返神经损伤、术中出血量以及术后引流量的差异。 结果 应用喉返神经常规显露肉眼识别保护法,喉返神经顺利识别39例（86.7%）,确认识别时间为（3.4±0.9）min;余6例（13.3%）常规显露未顺利识别喉返神经,经术中细致解剖确认喉返神经时间延长至（16.5±3.2）min,应用神经监测联合肉眼识别保护,喉返神经识别率为100%,确认识别时间为（2.2±0.8）min;暂时性及永久性喉返神经损伤率在神经监测组较常规显露组低,分别为6.7% vs. 22.2%（P<0.05）,0 vs. 2.2%（P>0.05）;神经监测组术中出血量及术后引流量较常规显露组少,分别为（12.2±2.9）mL vs.（13.1±1.8）mL（P>0.05）,（40.6±2.8）mL vs.（50.8±3.2）mL（P<0.05）。结论 甲状腺再次手术中,术中喉返神经监测较常规显露能加快完成喉返神经的确认识别,提高喉返神经的识别率,有效降低暂时性喉返神经损伤率,并且减少术后引流量,有利于术后恢复,在喉返神经周围危险区操作时,连续实时监测发现肌电信号振幅的危险改变,增加手术安全性。     

显露喉返神经在高风险甲状腺手术中对喉返神经保护作用

目的:探讨高风险甲状腺手术中显露喉返神经对预防喉返神经受损的临床作用,并分析神经检测临床价值,为临床诊治提供参考。方法:选择2011年1月—2014年6月264例高风险甲状腺手术患者,根据术中是否显露喉返神经分为显露组160例,未显露组104例,对比两组患者喉返神经受损率、手术时间等临床指标;显露组160例根据是否实施神经监测分为监测组72例,未监测组88例,对比两组寻找神经时间、喉返神经损伤率等指标。结果:显露组手术时间为(132.73±24.67)min,明显长于未显露组的(118.21±19.46)min(t=3.884,P=0.028);显露组与未显露组低钙血症发生率相近(P0.05);显露组喉返神经损伤率为2.50%,明显低于未显露组的8.65%(χ2=5.647,P=0.009)。监测组喉返神经定位时间为(4.68±0.84)min,明显短于未监测组的(17.46±2.37)min(t=7.551,P=0.000);监测组喉返神经损伤率与未监测组相近,组间差异无统计学意义(χ2=0.927,P=0.452)。结论:高风险甲状腺手术中显露喉返神经可以有效降低喉返神经受损率,神经监测可以有效加快神经定位时间,但对降低喉返神经损伤率无明显效果。     

显露喉返神经在甲状腺切除术中的临床意义

目的探讨甲状腺手术中显露喉返神经对防止喉返神经损伤的价值。方法回顾性分析2 481例甲状腺手术患者的临床资料,其中术中显露喉返神经组1 425例和非显露喉返神经组1 056例,比较两组间并发喉返神经损伤的几率。结果显露喉返神经组喉返神经暂时性损伤31例,损伤率为2.18%,无永久损伤病例;非显露喉返神经组喉返神经损伤44例,损伤率为4.17%,其中暂时损伤39例,永久损伤为5例。两组喉返神经损伤率比较差异有统计学意义(P<0.01)。结论甲状腺手术术中显露喉返神经对保护喉返神经是安全和有效的,对预防或避免医源性喉返神经损伤有重要意义。     

显露喉返神经在甲状腺手术中的临床意义

目的 探讨甲状腺手术中常规显露喉返神经对于减少其损伤的临床意义.方法 770例全麻下行甲状腺手术患者,解剖显露喉返神经430例,未解剖显露喉返神经340例.比较两组患者神经损伤的发生率.结果 显露神经组430例中2例（0.47％）出现暂时性声音嘶哑,无永久性喉返神经损伤.未显露组340例中有8例（2.35％）出现喉返神经损伤,其中6例为暂时性损伤,2例为神经永久性损伤.组间比较差异有统计学意义（P＜0.05）.结论 甲状腺手术时显露喉返神经可明显降低喉返神经损伤的发生率.     

显露喉返神经在甲状腺手术中预防喉返神经损伤的作用

目的探讨甲状腺手术中显露喉返神经对预防喉返神经损伤的作用。方法回顾分析372例甲状腺手术病例资料，显露喉返神经组215例，未显露喉返神经组157例。结果显露组喉返神经损伤1例，发生在甲状腺癌颈淋巴结清扫术；未显露组损伤6例，主要发生在甲状腺次全切除和腺叶切除术。显露组发生喉返神经损伤的几率显著低于未显露组（P〈0．05）。结论甲状腺次全切除、腺叶切除术和甲状腺癌根治术术中常规显露喉返神经能预防喉返神经损伤。     

甲状腺手术中喉不返神经的手术操作技巧

目的了解喉不返神经解剖特点和变异,总结甲状腺手术中发现喉不返神经的方法和预防损伤的经验。方法分析5例甲状腺手术中发现的喉不返神经患者的临床资料,分析喉不返神经手术操作技巧。结果经手术证实本组5例喉不返神经均位于右侧,术中有3例切断了喉不返神经,2例出现了声音嘶哑,1例神经吻合后声音无明显变化。结论甲状腺手术中在颈动脉鞘和喉之间,除外甲状腺中静脉之外的任何横行索状结构均不能首先切断,需显露喉返神经后再作处理;甲状腺手术中如探查喉返神经缺如,均需显露颈段迷走神经,以寻找是否存在喉不返神经。     

甲状腺手术中显露喉返神经的安全性探讨

目的 探讨甲状腺手术中显露喉返神经对术后并发症的影响.方法 对397例甲状腺切除术患者分两组进行回顾性分析,其中显露喉返神经210例,不显露187例.比较两组术后喉返神经损伤和低钙血症发生情况.结果 显露组喉返神经损伤率低于不显露组,差异有统计学意义(P<0.05);甲状腺功能亢进的患者喉返神经损伤率高于甲状腺功能正常和甲状腺功能减退者,差异有统计学意义(P<0.05);显露组暂时性低钙血症的发生率高于不显露组,差异有统计学意义(P<0.05);显露组永久性并发症发生率低于不显露组,差异有统计学意义(P<0.05).结论 甲状腺手术中全程显露喉返神经可减少其损伤,并可降低永久性并发症的发生率.     

非返性喉返神经解剖特征及术中保护策略（附22例报告）

目的 探讨非返性喉返神经（NRLN）的变异规律及处理经验。方法 回顾性分析吉林大学第一医院甲状腺外科同一医疗组2009年1月至2015年12月实施的5900例甲状腺及甲状旁腺手术病例资料,其中22例术中发现NRLN。结果 5900例甲状腺及甲状旁腺手术共显露喉返神经8850条,其中右侧4451条,左侧4399条;共发现非返性喉返神经22条,全部位于右侧,发生率为0.5%（22/4451）;其中Ⅰ型4条、2A型10条,2B型8条。NRLN发生与性别、甲状腺肿瘤性质、甲状腺或者甲状旁腺手术、神经监测仪应用等均无相关性。喉返神经监测病人中3例NRLN显露时间为（4.2±1.8）min,常规显露病人中19例NRLN显露时间为（9.7±2.1）min,二者差异有统计学意义（P<0.05）。22条NRLN无一损伤。结论 NRLN临床少见,以右侧居多;熟悉解剖特征、提高对NRLN认识、术中精细解剖及喉返神经常规显露是预防NRLN损伤的关键。     

显露喉返神经在甲状腺手术中的应用价值及预防其损伤的对策

【摘要】〓目的〓探讨常规显露喉返神经在甲状腺手术中的应用价值以及预防其损伤的对策。方法〓回顾性分析本科近5年来336例在初次行甲状腺手术患者的临床资料,根据术中是否显露喉返神经将其分为显露喉返神经组205例和未显露喉返神经组131例。根据喉返神经损伤的判断标准,比较两组患者术后喉返神经损伤情况。结果〓显露喉返神经组205例中有2例(0.98%)出现暂时性声音嘶哑,1个月未经特殊处理后声音恢复,无永久性损伤病例。未显露喉返神经组131例中有6例(4.58%)出现喉返神经损伤,其中4例为暂时性损伤,2例为永久性损伤。组间比较差异有统计学意义(P<0.05)。结论〓在甲状腺手术中规范化显露并保护喉返神经可有效预防与减少喉返神经的损伤。     

Intraoperative nerve monitoring is associated with a lower risk of recurrent laryngeal nerve injury: A national analysis of 17,610 patients

BackgroundBased on current evidence, the benefit of intraoperative nerve monitoring (IONM) in thyroid surgery is equivocal.MethodsAll patients who underwent planned thyroid surgery in the 2016–2018 ACS NSQIP procedure-targeted thyroidectomy dataset were included. Multivariable regression analyses were performed to examine the association between nerve monitoring and recurrent laryngeal nerve (RLN) injury while adjusting for patient demographics, extent of surgery, and perioperative variables.ResultsIn total, 17,610 patients met inclusion criteria: 77.8% were female, and the median age was 52 years. IONM was used in 63.9% of cases. Of the entire cohort, 6.1% experienced RLN injury. Cases with IONM use had a lower rate of RLN injury compared to those that did not use IONM (5.7% vs. 6.8%, p = 0.0001). After adjustment, IONM was associated with reduced risk of RLN injury (OR 0.69, 95% CI 0.59–0.82, p < 0.0001).ConclusionsNationally, IONM is used in nearly two thirds of thyroid surgeries. IONM is associated with a lower risk of recurrent laryngeal nerve injury.     

Thyroid Surgery and the Usefulness of Intraoperative Neuromonitoring,a Single Center Study

Purpose/Aim of study: To compare the use of intraoperative neuromonitoring (IONM) versus visualization of the recurrent laryngeal nerve (RLN) alone in thyroid surgery with regard to incidence in postoperative RLN injury and operation time. Materials and Methods: This retrospective cohort study was performed in the Amphia Hospital, the Netherlands. All thyroid gland operations were collected from September 2009 to October 2012. For each case we recorded the patient characteristics, indication for surgery, intraoperative data, complications, results of pathological evaluation, and consultation of a ENT-surgeon. Research of current literature and statistical analysis was performed. Results: In total, 147 patients were included and classified into an IONM and non-IONM group. Both groups were similar in demographical aspects and indications for surgery. In total, we had 170 nerves at risk (NAR). In both groups, there were 85 (50%) NAR. Overall injury to the RLN was 6%. A statistical significant decrease of permanent RLN injuries was noticed in the IONM group compared to the non-IONM group (n = 0 vs n = 6; p = .044). In transient RLN injury, no difference was noticed (n = 2 vs n = 2). Operation time with or without IONM was not significantly different for hemithyroidectomies, neither for total thyroidectomies. Conclusion: IONM is a useful tool as an adjunct in thyroid surgery to prevent RLN injury. A statistical significant decrease in permanent RLN injury with the use of IONM was found, but it did not significantly decrease time of operation.     

NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?

BACKGROUND: Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. METHODS: This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation. RESULTS: One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false-positive and one true-positive results. Eighty-six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups. CONCLUSION: Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention.     

喉返神经隧道解剖法结合神经监测在腔镜甲状腺手术中的应用

目的:探讨喉返神经隧道解剖法结合神经监测在腔镜甲状腺手术中的应用价值。方法:回顾分析2014年11月至2018年12月施行的141例腔镜甲状腺手术,术中均采用喉返神经隧道解剖法结合神经监测技术。其中甲状腺良性结节93例,甲状腺恶性肿瘤48例;行单侧腺叶切除术52例,单侧甲状腺癌根治术44例,双侧甲状腺癌根治术4例,41例部分切除术。结果:140例手术顺利完成,1例因喉返神经横断伤转开放手术行神经对端吻合;术后9例(9/141,6.38%)暂时性神经麻痹,无永久性声音嘶哑患者。结论:腔镜甲状腺手术中采用喉返神经隧道解剖法结合神经监测技术可快速定位喉返神经,降低手术难度,提高手术安全性,利于腔镜甲状腺手术更好地在基层医院推广普及。     

术中神经监测技术在复杂甲状腺手术中的应用

目的 探讨应用术中神经监测技术（intra operative neuromonitoring,IONM）,以减少复杂甲状腺手术喉返神经损伤。方法 吉林大学中日联谊医院甲状腺外科2009年3~7月对132例复杂甲状腺手术病人,共186支高风险喉返神经行术中神经监测。在甲状腺切除前后分别探测迷走神经及喉返神经肌电信号。甲状腺手术前后常规检查声带活动度。结果 除术前声带麻痹4例,余182支喉返神经均可在甲状腺切除后测得明显肌电信号,未发生缝合切口前神经肌电信号消失,提示神经电传导功能良好。精确检出非返性喉返神经2例。结论 术中喉返神经监测使喉返神经显露更加便捷,更加确切,并可验证喉返神经功能完整性。在高风险、复杂甲状腺术中应用神经监测是降低喉返神经损伤率的一种重要辅助措施。     

甲状腺手术中显露喉返神经的方法与价值

目的:探讨甲状腺手术中显露喉返神经的方法及其临床价值。方法:将116例甲状腺手术患者分为喉返神经显露组(60例)和未显露组(56例),比较2组术后喉返神经损伤情况。结果:显露组1例(2%)出现暂时性的声音嘶哑;未显露组4例(7%)出现神经损伤,其中2例出现暂时性的声音嘶哑,2例出现永久性的声音嘶哑。结论:甲状腺手术中常规显露喉返神经,可以降低喉返神经损伤的发生率,亦是预防其损伤的有效方法。