术中喉返神经监测在甲状腺癌再次手术中的应用价值

目的:探讨术中神经监测(IONM)在甲状腺癌再次手术中预防喉返神经(RLN)损伤的临床应用价值。方法:选择2012年1月—2014年12月行甲状腺癌再次手术137例患者,其中41例行术中单纯RLN肉眼识别(对照组),96例行术中RLN肉眼识别+IONM(研究组)。比较两组之间RLN识别及损伤率、平均手术时间、术后引流量、甲状旁腺损伤率的差异。结果:研究组RLN识别率100%(96/96),对照组为82.3%(34/41),差异有统计学意义(P0.05);与对照组比较,研究组RLN损伤率(1.0% vs.9.8%)、术后引流量(38.1 mL vs.44.1 mL)均明显降低(均P0.05);甲状旁腺损伤率两组间差异无统计学意义(8.3% vs.12.2%,P0.05)。结论:IONM的应用能更好地提高甲状腺癌再次手术中RLN的识别率及降低其损伤率,减少术后并发症。

Application value of intraoperative neuromonitoring of recurrent laryngeal nerve during reoperation for thyroid carcinoma

Objective: To investigate the clinical application value of intraoperative neuromonitoring (IONM) in the prevention of recurrent laryngeal nerve (RLN) injury during repeated operation for thyroid carcinoma. Methods: One hundred and thirty-seven patients scheduled to undergo a repeated operation for thyroid cancer from January 2012 to December 2014 were selected. Of the patients, RLN in 41 cases was identified by naked- eye inspection only during operation (control group), and in 96 cases was identified by naked- eye inspection combined with IONM (study group). The RLN recognition and injury rates, postoperative drainage and incidence of parathyroid damage between the two groups were compared. Results: The RLN recognition rate was 100% (96/96) in study group and 82.3% (34/41) in control group, and the difference had statistical significance (P<0.05). In study group versus control group, the incidence of RLN damage (1.0% vs. 9.8%) and postoperative drainage (38.1 mL vs. 44.1 mL) were significantly reduced (both P<0.05). The difference in incidence of parathyroid injury between the two groups had no statistical significance (8.3% vs. 12.2%, P>0.05). Conclusion: Application of IONM during repeated surgery for thyroid cancer can effectively improve RLN recognition and reduce the incidence of RLN injury, as well as reduce the incidence of complications.