甲状旁腺手术中喉返神经常规显露与术中神经监测的比较

Conventional visualization versus intraoperative nerve monitoring in parathyroidectomy

目的比较甲状旁腺手术中肉眼常规显露与应用术中神经监测(intraoperative neuromonitoring,IONM)进行喉返神经(recurrent laryngeal nerve,RLN)辨识及保护的区别,探讨IONM在甲状旁腺手术中的应用价值。方法分析2014年1月-2016年4月解放军总医院普通外科收治的37例单发甲状旁腺腺瘤患者的临床资料,其中IONM组23例术中应用IONM,非IONM组14例采用常规肉眼识别及RLN全程显露。对比两组手术时长、RLN探查时间、术中出血量、术后引流量及RLN损伤率等方面的差异。结果非IONM组和IONM组的平均手术时长分别为(57.3±11.3)min和(47.9±10.6)min,RLN探查时间分别为(15.9±2.2)min和(9.7±2.1)min,术中出血量分别为(24.0±11.6)ml和(15.3±6.9)ml,术后引流量分别为(43.9±11.9)ml和(35.1±9.2)ml,差异均有统计学意义(P<0.05)。两组RLN暂时性损伤率分别为14.3%和4.3%,永久性损伤率均为0。结论 IONM可快速识别定位RLN,缩短手术时长,避免不必要的组织损伤,提高手术的安全性,在甲状旁腺手术中值得推广。

Objective To compare the difference between intraoperative nerve monitoring（IONM） and conventional visualization on identifying and protecting recurrent laryngeal nerve（RLN） during parathyroidectomy and discuss the application value of IONM in parathyroidectomy. Methods Clinical data about 37 patients who had single parathyroid adenoma and underwent parathyroidectomy from January 2014 to April 2016 in the department of general surgery of Chinese PLA General Hospital were analyzed. IONM was used in 23 patients in IONM group and conventional exposure was applied in 14 patients in non-IONM group. The operating time, RLN identification time, intraoperative bleeding volume, postoperative drainage volume, injury rates of RLN were compared between two groups. Results There were significant differences in the average operating time, RLN identification time, intraoperative bleeding volumes and postoperative drainage volume between non-IONM group and IONM group [（57.3±11.3） min vs（47.9±10.6） min,（15.9±2.2） min vs（9.7±2.1） min,（24.0±11.6） ml vs（15.3±6.9） ml,（43.9±11.9） ml vs（35.1±9.2）ml, P〈0.05]. The RLN temporary injury rates were 14.3% and 4.3% respectively and the permanent injury rates in both groups were 0. Conclusion IONM can identify and locate RLN quickly, shorten the operating time, avoid unnecessary tissue damage and enhance the safety of operating, which is worthy of promoting in parathyroidectomy.