喉返神经监测技术在腔镜辅助cT1N0~1a分化型甲状腺癌手术中的应用研究

Application of Intraoperative Recurrent Laryngeal Nerve Monitoring in Endoscopy-assisted Radical Thyroidectomy for cT1N0-1a Differentiated Thyroid Cancer

目的:探讨喉返神经监测技术(IONM)在腔镜辅助cT1N0~1a分化型甲状腺癌(DTC)手术中的应用价值。方法:选取2015年1月-2017年12月本院收治的68例腔镜辅助小切口cT1N0~1a DTC手术患者作为研究对象,根据术中是否使用IONM,将患者分为观察组(n=38,通过使用IONM监测喉返神经来判断喉返神经有无损伤)和对照组(n=30,全程暴露喉返神经),比较两组的手术相关指标。结果:观察组IONM的阳性预测值为42.86%,阴性预测值为97.73%,灵敏度为75.00%,特异度为91.49%,诊断准确度为92.16%。观察组的喉返神经(RLN)识别暴露时间为(8.30±1.56)min,明显短于对照组的(12.00±1.58)min,差异有统计学意义(P<0.05);观察组的RLN识别率为100%,显著高于对照组的92.5%,差异有统计学意义(P<0.05)。两组的RLN暂时性损伤和永久性损伤发生率比较,差异均无统计学意义(P>0.05)。结论:IONM在腔镜辅助cT1N0~1a DTC手术中可以帮助外科医师尤其是年轻医师更准确快捷的识别暴露RLN,预判其解剖及功能完整性,减少术后声带麻痹的发生率,避免医疗纠纷。

Objective: To explore the value of application of intraoperative recurrent laryngeal nerve monitoring(IONM) in endoscopy-assisted radical thyroidectomy for cT1 N0-1 a differentiated thyroid cancer(DTC). Method: A total of 68 patients who underwent endoscopy-assisted radical thyroidectomy for cT1 N0-1 a differentiated thyroid cancer from January 2015 to December 2017 in our hospital were selected as the research objects, patients were divided into the observation group(n=38, IONM was used to monitor the recurrent laryngeal nerve to determine if there was any damage to the recurrent laryngeal nerve) and the control group(n=30, full exposure to recurrent laryngeal nerve), according to whether IONM was used during the operation. The two groups were compared for surgically related indicators. Result: The positive predictive value of IONM in the observation group was 42.86%, the negative predictive value was 97.73%, the sensitivity was 75.00%, the specificity was 91.49%, and the diagnostic accuracy was 92.16%. The recognition exposure time of the recurrent laryngeal nerve(RLN) in the observation group was(8.30±1.56) min, significantly shorter than(12.00±1.58) min in the control group, with statistically significant difference(P<0.05). The RLN recognition rate in the observation group was 100%, significantly higher than 92.5% in the control group, with statistically significant difference(P<0.05). There were no significant differences in the incidence of RLN temporary injury and permanent injury between the two groups(P>0.05). Conclusion: IONM in endoscopy-assisted radical thyroidectomy for cT1 N0-1 a DTC may help surgeons especially young surgeons to identify and expose RLN more accurate and quickly, prejudge the anatomical and functional integrity, reduce the risk of paralysis vocal cord, avoid medical disputes.