术中持续与间断神经监测技术在腔镜辅助甲状腺手术中的对比研究

Comparative study of continuous intraoperative neurologic monitoring and discontinuous neurologic monitoring in endoscopy-assisted thyroid surgery

目的对比持续术中神经监测(C-IONM)和间断性术中神经监测(I-IONM)在腔镜辅助甲状腺手术中的临床效果。方法回顾性分析2016年5月至2018年12月59例接受腔镜辅助甲状腺手术的患者资料,根据不同术中神经监测方式分为C-IONM组和I-IONM组。采用SPSS 21.0统计软件进行分析,迷走神经及喉返神经功能评估采用(x±s)表示,行独立t检验;喉返神经损伤情况行χ^2检验。P<0.05为检验标准。结果两组术中神经监测时间差异无统计学意义(P>0.05)。59例患者共解剖显露喉返神经86条,其中11条术中出现肌电图(EMG)振幅下降>50%,且在停止手术操作后10 min内均逐渐恢复至初始R1信号水平的70%以上,平均恢复时间为(6.7±2.5) min,两组患者术中喉返神经损伤及恢复情况差异无统计学意义(P>0.05)。两组患者术毕时EMG振幅和潜伏期较同组APS电极刺激初始时变化差异无统计学意义(P>0.05)。光镜下两组迷走神经和喉返神经结构正常,纤维细胞完整,无神经束水肿及神经内血管损伤发生。结论腔镜辅助甲状腺手术中C-IONM技术和I-IONM技术在降低迷走神经和喉返神经损伤方面疗效近似,两种神经监测技术对患者神经功能变化无影响,均安全可靠。

Objective To compare the clinical effects of continuous intraoperative neuromonitoring(c-ionm) and intermittent intraoperative neuromonitoring(i-ionm) in endoscopic assisted thyroid surgery.Methods Data of 59 patients undergoing endoscopic assisted thyroid surgery from May 2016 to December 2018 were retrospectively analyzed, and they were divided into the c-ionm group and the i-ionm group according to different intraoperative neuromonitoring methods. SPSS 21.0 statistical software was used for analysis. The function evaluation of vagus nerve and recurrent laryngeal nerve was expressed by (x±s), and independent t test was performed. χ^2 test was performed for recurrent laryngeal nerve injury. P<0.05 indicated the difference was statistically significant. Results There was no significant difference in intraoperative nerve monitoring time between the two groups(P>0.05). Among the 59 patients, 86 recurrent laryngeal nerves were dissected and exposed, among which 11 showed a decrease of EMG amplitude by >50% during the operation, and gradually recovered to more than 70% of the initial R1 signal level within 10 min after the operation was stopped, with an average recovery time of(6.7±2.5) min. There was no significant difference between the two groups in the injury and recovery of recurrent laryngeal nerves during the operation(P>0.05). There was no significant difference in EMG amplitude and latency between the two groups compared with the APS electrode stimulation at the beginning(P>0.05). Under the light microscope, the structure of the vagus nerve and recurrent laryngeal nerve in the two groups was normal,the fiber cells were complete,and there was no neurobundle edema and neurovascular injury.Conclusion The efficacy of c-ionm and i-ionm in endoscopic thyroid surgery is similar in reducing the injury of vagus and recurrent laryngeal nerve. The two neuromonitoring techniques have no effect on the neurological function of patients,and both are safe and reliable.