术中神经生理监测技术在甲状腺再手术中的应用效果观察

Intraoperative neurophysiological monitoring for protection of recurrent laryngeal nerve in thyroid reoperation

目的探讨术中神经生理监测(IONM)技术在甲状腺再手术中的临床应用价值。方法选取2010年1月至2020年7月在杭州师范大学附属医院接受再次甲状腺手术的患者109例。其中应用IONM联合肉眼识别保护喉返神经的患者65例(IONM组),暴露神经94条;常规显露保护喉返神经的患者44例(对照组),暴露神经65条。比较两组患者术中喉返神经识别率、喉返神经确认时间、喉返神经损伤率、暂时性喉返神经损伤率、永久性喉返神经损伤率、术中出血量以及手术时间的差异。结果IONM组喉返神经识别率明显高于对照组(96.8%比75.4%,P<0.05),喉返神经确认时间短于对照组[(5.3±2.3)min比(6.9±2.5)min,P<0.05]。两组患者喉返神经损伤率、永久性喉返神经损伤率比较差异均无统计学意义(5.3%比13.8%、3.2%比3.1%,均P>0.05);IONM组患者暂时性喉返神经损伤率低于对照组(2.1%比10.8%,P<0.05),术中出血量明显少于对照组(P<0.05);两组患者手术时间比较差异无统计学意义(P>0.05)。结论IONM技术能有效提高再次甲状腺手术中喉返神经识别率,术中加快对神经的确认,降低暂时性喉返神经损伤率,减少术中出血量,而并不增加手术时间,建议再次甲状腺手术时可以考虑应用。

Objective To evaluate the clinical value of intraoperative neurophysiological monitoring(IONM)for protection of recurrent laryngeal nerve(RLN)in thyroid reoperation.Methods A total of 109 patients who underwent thyroid reoperation in the Affiliated Hospital of Hangzhou Normal University from January 2010 to June 2020 were included in this study.The IONM was applied for identification of RLN in 65 cases with 94 RLNs(IONM group)and not applied in 44 cases with 65 RLNs(control group).The RLN identification rate,RLN confirmation time,the rate of RLN injury,intraoperative bleeding volume and the operative time were compared between the two groups.Results The RLN recognition rate in the IONM group was significantly higher than that of the control group(96.8%vs.75.4%,P<0.05).The RLN confirm time in the IONM group was significantly shorter than that in the control group(5.3±2.3 min vs.6.9±2.5 min,P<0.05).The temporary RLN injury rate in the IONM group was significantly lower than that in the control group(2.1%vs.10.8%,P<0.05).However,there were no significant differences in overall and the permanent RLN injury rate between the two groups(5.3%vs.13.8%,3.2%vs.3.1%,P>0.05).The amount of intraoperative bleeding volume in the IONM group were significantly less than those in the control group(P<0.05),and there was no significant difference in the operation time between the two groups(P>0.05).Conclusion IONM in thyroid reoperation is helpful to improve RLN identification rate,shorten RLN confirming time,decrease intraoperative bleeding and reduce the temporary RLN injury rate during thyroid reoperations without increasing the operating time.