喉返神经实时监测与常规暴露在甲状腺手术中的比较

目的 比较甲状腺手术中喉返神经实时监测与常规暴露的差别,探讨两种方式的优缺点并介绍喉返神经监测仪的应用.方法 采用NIM-ResponseTM实时肌电图监测仪对43例患者行喉返神经实时监测,采用常规暴露法对70例患者行喉返神经全程显露,比较两组之间喉返神经探查时间、手术时间、喉返神经损伤率、喉返神经损伤后再次手术有效率、术中出血量、术后引流量及住院费的差异.结果 实时监测组探查喉返神经79根,常规暴露组探查喉返神经85根.实时监测组平均喉返神经探查时间、平均手术时间较常规暴露组短,分别为（6.2±1.2）min vs.（13.6±2.5）min,P〈0.01;（102.3±8.9）min vs.（139.8±18.6）min,P〈0.01;而暂时性及永久性喉返神经损伤率较常规暴露组低,分别为1.35% vs.10.26%（P〈0.05）,0 vs.2.56%（P〉0.05）;喉返神经损伤后再次手术有效率较常规暴露组高,60% vs.14.3%（P〉0.05）;两组之间出血量、引流量无明显差异;实时监测组平均住院费较常规暴露组高,（13 962.6±125）元 vs.（10 851.6±89）元,P〈0.01.结论 喉返神经监测仪实时监测较常规暴露能更快完成喉返神经探查,缩短手术时间,降低暂时性喉返神经损伤率,但费用较高.两组之间永久性喉返神经损伤率、再次手术有效率、出血量、引流量无统计学差异.

Comparation of real-time recurrent laryngeal nerve monitoring and conventional exposure during thyroidsurgery

Objective To compare the difference between real-time recurrent laryngeal nerve （RLN） monitoring and conventional exposure during thyroid operation, explore the advantages and disadvantages of these two methods and introduce the application of real-time laryngeal eleetromyography. Methods NIM-ResponseTM electromyographlc monitoring system was used in 43 patients in the real-time monitoring group, conventional exposure of RLN was implemented in 70 patients in the conventional exposure group. Compare the time for RLN exploration, time for operation,injury rates of RLN, effective rates of reoperation for RLN injury, bleeding volume, drainage volume and hospital charges between two groups. Results 79 RLNs of 43 patients were explored in the real-time monitoring group,while 85 RLNs of 70 patients were explored in the conventional exposure group. The median time for RLN exploration,time for operation in the real-time monitoring group was shorter than the conventional exposure group, （6,2 ±1.2）min vs. （13.6 ±2.5） min（P 〈 0.01） and（102.3 ± 8.9） min vs. （139.8 ± 18.6） min（P 〈0.01） respectively. The transient and permanent RLN injury rate was 1.35% vs. 10. 26% （P 〈0. 05） ,0% vs. 2. 56% （P 〉 0. 05） respectively,lower in the conventional exposure group. The effective rate of reoperation for B.LN injury was higher in the real-time monitoring group,60% vs. 14. 3% （P 〉0. 05） ,while bleeding volume and drainage volume showed no statistically difference. Hospital charge in the real-time monitoring group was higher, （13 962. 6 ± 125） yuan vs. （ 10 851.6 ± 89 ） yuan, with significant difference （ P 〈 0. 01 ）. Conclusions Compared with the conventional exposure group, the real-time RLN monitoring group need less time to complete RLN exploration and operation,decreased transient RLN injury rate, but the hospital charge was higher. Permanent RLN injury rate, effective rate of reoperation for RLN injury, bleeding volume and drainage volume show no statistically differencebetween two groups.