术中喉返神经监测在微创McKeown食管切除术中的应用研究

Application of Intraoperative Recurrent Laryngeal Nerve Monitoring in Minimally Invasive McKeown Esophagectomy

目的:分析术中喉返神经监测在微创McKeown食管切除术中的应用价值。方法:回顾性分析南通市肿瘤医院2020年1月-2021年1月进行微创McKeown食管切除术治疗食管鳞状细胞癌患者78例,其中使用喉返神经监测的纳入研究组(38例);未接受喉返神经监测的纳入对照组(40例)。比较两组手术指标、并发症,分析肌电图(EMG)波形异常诊断术后声带麻痹的价值。结果:研究组的喉返神经暴露时间、双侧喉返神经旁淋巴结清扫时间短于对照组,术中出血量少于对照组(P<0.05);两组住院时间比较,差异无统计学意义(P>0.05)。研究组并发症发生率为13.16%,低于对照组的42.50%(P<0.05)。EMG波形异常诊断术后声带麻痹的特异度为82.4%,敏感度为100%,阳性预测值为40.0%,阴性预测值为100%,准确率为84.2%。结论:喉返神经监测用于微创McKeown食管切除术可减少手术时间和出血量,降低术后并发症发生风险,其中EMG波形异常诊断声带麻痹敏感度和特异度较高。

Objective:To analyze the application value of intraoperative recurrent laryngeal nerve monitoring in minimally invasive McKeown esophagectomy.Method:A total of 78 patients with esophageal squamous cell carcinoma who underwent minimally invasive McKeown esophagectomy in the Nantong Tumor Hospital from January 2020 to January 2021 were retrospectively analyzed.Among them,those who used recurrent laryngeal nerve monitoring were included in the study group (38 cases),those who did not receive recurrent laryngeal nerve monitoring were included in the control group (40 cases).The surgical indicators and complications of the two groups were compared,and the value of abnormal waveform of electromyography (EMG) in the diagnosis of postoperative vocal cord paralysis was analyzed.Result:The exposure time of recurrent laryngeal nerve and bilateral lymph node dissection time in the study group were shorter than those in the control group,and the intraoperative bleeding volume was less than that in the control group (P<0.05),but there was no significant difference in the hospitalization time between the two groups (P>0.05).The complication rate in the study group was 13.16%,lower than 42.50% in the control group (P<0.05).The specificity of abnormal waveform of EMG in the diagnosis of postoperative vocal cord paralysis was 82.4%,the sensitivity was 100%,the positive predictive value was 40.0%,the negative predictive value was 100%,and the accuracy was 84.2%.Conclusion:The use of recurrent laryngeal nerve monitoring in minimally invasive McKeown esophagectomy can reduce the operation time and blood loss,and reduce the risk of postoperative complications.Abnormal waveform of EMG have high sensitivity and specificity for the diagnosis of vocal cord paralysis.