术中喉返神经监测技术在完全腔镜甲状腺手术中的应用研究

The analysis of intraoperative neuromonitoring of recurrent laryngeal nerves in totally endoscopic thyroidectomy

目的:探讨术中神经监测技术在完全腔镜甲状腺手术中的应用价值。方法:总结74例完全腔镜甲状腺手术患者的临床资料,39例术中应用神经监测仪(观察组),35例未使用神经监测仪(对照组),对比分析两组患者的性别、年龄、手术相关指标、住院时间、患者主观感受等。结果:两组患者平均年龄、性别组成、肿瘤大小、良恶性比例、术中出血、术后疼痛评分VAS、术后3天反流症状指数量表评分(reflux symptom index,RSI)、术后引流量与住院时间、术后3个月随访噪音障碍指数(voice handicap index,VHI)等差异均无统计学意义(P>0.05);观察组手术时间短于对照组[(98.6±37.9)min vs.(136.7±45.3)min,P<0.05]。对照组出现2例暂时性声音嘶哑,无永久性声音嘶哑。结论:腔镜甲状腺手术中应用神经监测技术可帮助术者更加熟练顺畅地完成手术,提高手术效率,预防喉返神经损伤。但术中并发症及手术创伤的大小与术者的手术经验、操作精细程度有很大关系。

Objective：The aim of this study was to find out the intraoperative neuromonitoring （IONM） of recurrent laryngeal nerves is better or not in totally endoscopic thyroidectomy （TET）. Methods：The study included 74 patients undergoing TET. There were 39 patients undergoing the TET with the IONM, and 35 patients undergoing the TET without it. Information about gender, age, oper- ation data,intraoperative and postoperative complications, hospital stay and patients＇ subjective feelings were comparatively analyzed. Results ： No difference was noted between the two groups in the term of demographic data for example gender, age, size of nodular diam- eter, proportion of benign and malignant,intraoperative blood loss, postoperative pain, the reflux symptom index in the postoperative 3rd day, drainage volume, hospital stay, voice handicap index 3 months later （ P 〉 0.05 ）. The group with IONM had shorter operating time than the control group [ （98.6 ± 37.9 ） min vs. （ 136.7 ± 45.3 ） min,P 〈 0.05 ]. 2 cases of temporary hoarseness was found in control group, no permanent hoarseness occurred. Conclusions：The IONM has a lot of benefits on the smooth of the TET, plays an important role in improvement of operative efficiency and prevention of injury of recurrent laryngeal nerves. It is easier to anatomize laryngeal re- current nerve. But the experience of doctors and fine operations have much to do with the intraoperative complications and operative trauma.