喉返神经监测技术在分化型甲状腺癌中央区淋巴结清扫术中的临床应用

Application of recurrent laryngeal nerve monitoring in lymph node dissection of the central area of differentiated thyroid carcinoma

目的探讨在分化型甲状腺癌(DTC)中央区(Ⅵ区)淋巴结清扫术中喉返神经监测技术(IONM)的应用价值。方法 100例DTC患者分为应用IONM手术观察组(观察组)和不应用IONM手术对照组(对照组)各50例,比较两组手术相关指标的统计学差异。结果 (1)观察组探查暴露喉返神经(RLN)的时间、中央区淋巴结清扫手术时间平均分别为(7.5±3.3)min、(15.2±4.8)min,对照组分别为(14.0±4.2)min、(21.6±6.1)min,两组差异均有统计学意义(t=9.134 5、5.830 2,P=0.000 0、0.000 0)。(2)观察组暂时性RLN损伤发生率为2.0%(1/50),未发生永久性RLN损伤。对照组暂时性RLN损伤发生率为6.0%(3/50),永久性RLN损伤发生率为2.0%(1/50),但差异无统计学意义。结论 DTC患者中央区淋巴结清扫术中应用IONM可快速缩短探查暴露RLN的时间和有效保护RLN,还可能在一定程度上降低手术过程中RLN损伤的发生风险。但是任何仪器都不能改变手术操作本身是一项高风险技术的本质,该项技术可作为手术得力助手。

Objective To explore the value of application of intra-operative recurrent laryngealnerve monitoring（IONM）in lymph node dissection of the central area（Ⅵ area）of differentiated thyroidcarcinoma（DTC）.Methods One hundred patients suffered from DTC were divided into application group（observation group）and conventional surgery group（control group）with fifty patients in each.Patients inobservation group were performed with IONM,as control,other patients in control group were performed onconventional operation without this technology,and then differences of several surgery related indexesbetween the two groups were compared.Results（1）Time used in exposing recurrent laryngeal nerve andlymph node dissection of central area in observation group was（7.5±3.3）min and（15.2±4.8）min inaverage,（14.0±4.2）min and（21.6±6.1）min in control group respectively,with statistical difference（t =9.134 5,5.830 2,both P〈0.01）.（2）The occurrence rate of temporary injury of RLN in observation groupwas 2.0%（1/50）and 6.0%（3/50）in control group.The occurrence rate of permanent nerve injury was 2.0%（1/50）in control group and none in observation group,with no statistical difference.Conclusions IONMin lymph node dissection of the central area may help to expose RLN more quickly,protect RLN moreeffectively,reduce the risk of RLN injury,thus it is conformed that application of this technology may havea certain value in lymph node dissection of the central area of DTC.It should be known that any equipmentcannot change the high-risk technology as the essence of operation itself,and this technology may be usedas efficient assistant for surgeons.