喉返神经实时监测技术在高风险、复杂甲状腺术中临床应用价值

The clinical value of recurrent laryngeal nerve monitoring in high risk and complicated thyroid surgery

目的探讨喉返神经监测技术在高风险、复杂甲状腺手术中的应用及临床价值。方法回顾性分析自2015年5月至2016年12月行甲状腺手术的167例患者临床资料,包括巨大结节性甲状腺肿(包括胸骨后甲状腺肿)、桥本氏甲状腺炎、术前疑为甲状腺癌、再次甲状腺手术、术前声音嘶哑、甲状腺功能亢进以及甲状旁腺肿瘤等术中喉返神经显露困难、易损伤者。其中,喉返神经实时监测组76例,术中探查喉返神经129根;常规显露组91例,术中探查喉返神经132根。比较两组喉返神经损伤率、术中出血量、低钙血症发生率、淋巴漏发生率、住院时间及总住院费用。结果喉返神经实时监测组、常规显露组,喉返神经损伤发生率分别为2.3%(3/129)、10.6%(14/132),两组间比较,差异有统计学意义(P<0.01);暂时性喉返神经损伤发生率分别为1.6%(2/129)、9.1%(12/132),两组间比较,差异有统计学意义(P<0.01);永久性喉返神经损伤发生率分别为0.8%(1/129)、1.5%(2/132),两组间比较,差异无统计学差异(P>0.05)。两组患者术后低钙血症发生率、术后淋巴漏发生率、术中出血量及住院时间比较,差异无统计学差异(P>0.05)。喉返神经实时监测组、常规显露组,总住院费用分别为(17 428.96±5 303.00)元、(14 031.74±3 503.00)元,两组间比较,差异有统计学意义(P<0.01)。结论在高风险、复杂甲状腺术中,喉返神经实时检测可降低暂时性喉返神经损伤率,但住院费用偏高。对永久性喉返神经损伤率、出血量、住院时间、术后低钙血症发生率、术后淋巴漏发生率无明显影响。

Objective To investigate the application and clinical value of recurrent laryngeal nerve monitoring in high risk and complicated thyroid surgery.Methods A retrospective study was performed on 167 cases of patients who underwent thyroid surgery from May 2015 to December 2016.The thyroid surgeries included giant nodular goiter（including substernal thyroid goiter）,Hashimoto thyroiditis,preoperative suspected thyroid cancer,thyroid reoperation,preoperative vocal cord paralysis,hyperthyroidism,parathyroid tumor surgery and so on which were difficulty andeasy injury in the exposure of recurrent laryngeal nerve（RLN）.In 76 cases of the real-time monitoring group,129 RLN were detected;in 91 cases of the conventional exposure group,132 RLN were detected.Compare the injury rates of RLN,bleeding volume,rates of hypocalcemia,rates of lymphatic leakage,postoperative hospitalization time and hospital charges between the two groups.Results The recurrent laryngeal nerve injury（RLNI） rate in the real-time group and conventional exposure group were 2.3%（3/129） and 10.6%（14/132）,respectively;temporary RLNI rate were 1.6%（2/129） and 9.1%（12/132）,respectively,all the differences between the two groups were statistically significant（P〈0.01）.The permanent RLNI rate were 0.8%（1/129） and 1.5（2/132）,respectively,and there was no significant difference between the two groups（P〈0.05）.The rates of postoperative hypocalcemia,the rates of lymphatic leakageand bleeding volume and postoperative hospitalization time had no statistically significant difference（P〈0.05）.The total hospital charge of the real-time group and the conventional exposure group was（17 428.96 ±5 303.00） RMB and（14 031.74 ± 3 503.00） RMB,respectively,there was statistically significant difference between the two groups（P〈0.01）.Conclusion Compared with the conventional exposure surgery,the real-time monitoring reduced temporary RLNI rate,the hospital charges was higher in high risk and complicated thyroid surgery.Permanent RLNI rate,bleeding volume,postoperative hospitalization time,rates of hypocalcemia,rates of lymphatic leakage between the two groups has no statistically significant.