术中神经监测在全腔镜甲状腺手术中的应用

Application of intraoperative neuromonitoring system in the total endoscopic thyroidectomy

目的探讨在全腔镜甲状腺手术(total endoscopic thyroidectomy,TET)中应用术中神经监测(intraoperative neuromonitoring,IONM)技术的可行性和临床价值。方法接受TET病人122例,根据是否使用IONM分为IONM组和无IONM组。比较两组病人的手术时间、腺叶全切比例、喉返神经(recurrent laryngeal nerve,RLN)辨识率以及RLN相关并发症等指标。结果 IONM组腺叶全切比例为28.9%,无IONM组为6.5%,两组比较差异有统计学意义(P<0.05);两组手术时间分别为(118.7±27.8)分钟和(108.7±28.0)分钟,两组比较差异无统计学意义(P>0.05);随访期间两组均未出现永久性RLN功能障碍。结论 TET术中应用INOM简单可行,有助于RLN的定位和保护。

Objective To study the application of intraoperative neuromonitoring system（IONM）in detecting recurrent laryngeal nerve（RLN） during the total endoscopic thyroidectomy（TET）.Methods A retrospective study was performed on 122 TET cases admitted to Tongji Hospital from 2014 to 2016.All cases were divided as the INOM group and the non IONM group.The operation time,proportion of surgery and RLN related complication were compared in both groups.Results The proportion of TET in the INOM group was higher than that in the non INOM group（28.9% vs.6.5%,P = 0.001）.The operation time was slightly longer in the IONM group than that in the non IONM group [（118.7 ± 27.8） mins vs.（108.7 ± 28.0） mins,P = 0.10].No permanent PLN injury was observed in both groups during followup.Conclusion IONM appears to be a simple,feasible and effective way in protecting RLN during TET.