术中神经监测技术在难治性甲状腺癌手术中的应用

Application of intraoperative neuromonitoring in difficult thyroid carcinoma operation

目的探讨术中神经监测（intraoperative neuromonitoring, IONM）在难治性甲状腺癌手术中RLN损伤的意义。方法回顾性分析四川省肿瘤医院头颈外科2012年11月至2015年11月收治的难治性甲状腺癌手术102例，首次手术局部晚期TC 39例，二次手术TC 63例。根据是否术中应用IONM分为观察组（57例）和对照组（45例），评估术中2组寻找和解剖RLN时间和RLN损伤率。结果RLN全程显露时间观察组短于对照组（观察组（7.88±1.55）min，对照组（12.60±3.56）min，t=-2.449，P=0.044），2组间差异有统计学意义。2组间暂时性RLN损伤患者分别为3例（5.26%）和7例（15.56%）（P=0.161），2组永久性RLN损伤患者分别为0例和2例（4.44%）（P=0.192），差异无统计学意义。结论在难治性甲状腺癌手术中，在规范的手术操作基础上，应用IONM技术能减少寻找和解剖RLN时间，在降低RLN损伤风险上具有实用价值。

ObjectiveTo explore the value of intraoperative neuromonitoring （IONM） for recurrent laryngeal nerve （RLN） injury during difficult thyroid carcinoma operation.MethodsData of 102 patients admitted from Nov. 2012 to Nov. 2015 who underwent complex thyroid carcinoma operation were retrospectively analyzed.Among the 102 patients, 39 were receiving the first operation due to local advanced thyroid cancer, and 63 were receiving the second operation. According to whether IONM was applied, the patients were divided into the observation group （57 patients） and the control group （45 patients） . Difference of the time cost in exposing and dissecting RLN and RLN injury rate between the two groups was compared.ResultsThe time cost in exposing and dissecting RLN was shorter in the observation group （ （7.88±1.55） min） than in the control group （ （12.60±3.56） min） , with statistical difference （t=-2.449, P=0.044） . Three patients （5.26%） in the observation group and 7 patients （15.56%） in the control group had temporary RLN injury, with no statistical difference （P=0.161） . No one in the observation group and 2 patients （4.44%） in the control group had permanent RLN injury, and the difference had no statistical significance （P=0.192） .ConclusionsOn the basis of normative surgical procedure, IONM technology can reduce the time of exposing and dissecting RLN, and it has practical value in reducing the risk of RLN injury in difficult thyroid carcinoma operation.