预测性检查联合神经监测对甲状腺手术中发现喉不返神经的作用分析

Function analysis of detecting non-recurrent laryngeal nerve through predictive examination combined nerve monitoring during thyroid surgery

目的探讨预测检查联合神经监测对甲状腺手术中发现喉不返神经的作用,为后期甲状腺手术中保护非返性喉返神经(non-recurrent laryngeal nerve,NRLN),预防并减少NRLN损伤提供参考。方法收集2010年1月-2018年7月在本院行暴露喉返神经甲状腺手术的患者共2014例作为研究对象,根据是否实施预防性检查及术中神经监测将所有患者分为试验组(实施)940例及对照组(未实施)1070例,采用统计学方法比较两组患者的喉不返神经检出情况、手术识别喉不返神经时间、手术费用及喉不返神经损害情况等指标。结果试验组的喉不返神经确诊率高于对照组,P<0.05。试验组患者的识别喉不返神经时间和手术时间均比对照组短,P<0.05;但试验组手术费用比对照组高,差异有统计学意义,P<0.05。在喉不返神经的损伤方面两组患者没有统计学差异,P>0.05。结论在甲状腺手术中应用预测检查联合神经监测技术能够提高喉不返神经的确定率,缩短识别喉不返神经时间和手术时间,具有积极效果的临床应用价值,值得推广。

Objective To explore the effect of predictive examination combined with nerve monitoring in detecting non-recurrent laryngeal nerve during thyroid surgery,and to provide reference for protecting non-recurrent laryngeal nerve(NRLN)and preventing or reducing NRLN injury in later thyroid surgery.Methods 2014 patients who underwent thyroid surgery to expose recurrent laryngeal nerve from January 2010 to July 2018 were collected as the research objects.All patients were divided into experimental group(with performing surgery)and control group(without performing surgery)according to whether preventive examination and intraoperative nerve monitoring were carried out.The detection rate of non-recurrent laryngeal nerve,the time of identifying through surgery,the cost of surgery and the damage were compared.Results The diagnosis rate of experimental group was higher than that of the control group(P<0.05).The identifying time of the experimental group were shorter than that of the control group(P<0.05).The operation cost of the experimental group was higher than that of the control group(P<0.05).There was no statistical difference between the two groups in the NRLN injury(P<0.05).Conclusion The application of predictive examination combined with nerve monitoring technology in thyroid surgery can improve the determination rate of NRLN,shorten the time of identifying time and the operation time,so it has positive clinical application value and it is worth popularizing.