喉返神经监测仪在da Vinci机器人甲状腺癌手术中的应用

Application of the intraoperative neuromonitoring in the operation of da Vinci robot thyroid carcinoma

目的探讨喉返神经监测技术在da Vinci机器人甲状腺癌手术中的安全性及有效性。方法采用前瞻性研究方法,对济南军区总医院甲状腺乳腺外科2016年11月~2017年12月行da Vinci机器人甲状腺癌手术的患者随机分配,神经监测组80例患者(观察组),87例患者未使用神经监测仪(对照组)。对两组患者的喉返神经(recurrent laryngeal nerve,RLN)显露时间、手术时间、喉返神经损伤率(永久性/暂时性)、术中出血量、术后总引流量、住院费用以及术后6个月随访噪音障碍指数(voice handicap index,VHI)进行对比分析。结果两组患者RLN损伤率(永久性/暂时性)、术中出血量、术后总引流量以及术后6个月随访VHI等差异均无统计学意义(P均>0.05)。两组患者住院费用、RLN显露时间及手术时间差异均有统计学意义(P均<0.05)。结论用探测夹直接连接3臂金属杆监测RLN功能,对术中快速寻找和保护RLN有重要价值,节省手术时间。

OBJECTIVE To explore the safety and efficacy of laryngeal recurrent nerve monitoring technique in da Vinci robot operation on thyroid carcinoma.METHODS Using prospective research method, 167 patients with thyroid carcinoma underwent da Vinci robot operation were randomly divided into observation group（80 patients） and control group（87 patients） in Jinan Military General Hospital from November 2016 to December 2017.Neural monitor were not using in the control group. The exposure time of recurrent laryngeal nerve, operation time,the rate of recurrent laryngeal nerve injury（permanent/temporary）, int raoperative bleeding, postoperative total volume of drainage, hospitalization expenses, and postoperative 6 months follow-up Voice Handicap Index in the two groups were compared. RESULTS There was no statistical difference in the rate of recurrent laryngeal nerve injury（permanent/temporary）, intraoperative bleeding,postoperative total volume of drainage and 6 months followup Voice Handicap Index（P〉0.05）. There were significant differences in the hospitalization expenses, exposure time and operative time of recurrent laryngeal nerve in two groups（P〈0.05）. CONCLUSION Using the probe clamp to directly connect the 3-arm metal rod to monitor the RLN function is of great value for the rapid searching and protecting RLN and saving time during operation.