显露喉返神经在非神经监测与神经监测下单侧甲状腺手术中的临床分析

Clinical efficacy analysis of recurrent laryngeal nerve exposure in unilateral thyroid surgery with or without intraoperative neural monitoring

目的 探讨显露喉返神经在非神经监测与神经监测下单侧甲状腺手术中的临床效果分析。方法 回顾性分析南方医科大学顺德医院2019年1月至2020年11月66例单侧甲状腺手术患者临床资料,根据是否应用喉返神经监测技术分为非神经监测组和神经监测组,每组各33例。非神经监测组钝性分离直接显露喉返神经,神经监测组在神经监测提示下逐步显露喉返神经,对比分析两组患者手术出血量、喉返神经受损发生率、住院时间、医疗费用等。结果 两组患者手术出血量、住院时间差异无显著性(P> 0.05)。神经监测组术后暂时性喉返神经损伤率低于非神经监测组,但差异无显著性(P> 0.05);神经监测组医疗费用高于非监测组,差异有显著性(P<0.05)。结论 实施单侧甲状腺手术时,分别在非神经监测与神经监测下显露喉返神经具有一致的手术安全性及手术效果,但神经监测下显露喉返神经需要更高的经济成本,可在一定程度上减少喉返神经损伤的发生率。

Objective To analyze the clinical effect of recurrent laryngeal nerve(RLN) exposure in unilateral thyroid surgery with or without intraoperative neural monitoring(IONM).Method The clinical data of 66 patients who received the unilateral thyroid surgery in Shunde Hospital of Southern Medical University from January 2019 to November 2020 were retrospectively reviewed and analyzed.The application of IONM served as the categorization basis of two groups, with 33 cases in each group.In the group without nerve monitoring, the recurrent laryngeal nerve was directly exposed by blunt dissection, while in the group with IONM, the RLN was gradually exposed under the guidance of IONM.Then the amount of bleeding, the incidence of RLN injury, the length of stay and medical expenses of the two groups were compared and analyzed. Result There was no significant difference in the amount of bleeding and length of stay between the two groups(P > 0.05). The rate of temporary RLN injury in the group with IONM was lower than that in another group without IONM, but there was no significant difference(P > 0.05). The medical expenses in the group with IONM were significantly higher than that in another group without IONM(P < 0.05). Conclusion Whether the intraoperative neural monitoring is adopted or not, the operation safety and efficacy in the unilateral thyroid surgery is consistent in exposing the recurrent laryngeal nerve. However, the application of nerve monitoring entails a higher cost but helps to reduce the incidence of RLN injury to a certain extent.