神经探测技术在Miccoli腔镜辅助复杂甲状腺术中对喉返神经的保护作用

Protective effect of nerve detection technique on recurrent laryngeal nerve in Miccoli endoscopic assisted complex thyroidectomy

目的研究神经探测技术(IONM)在Miccoli腔镜辅助复杂甲状腺术中喉返神经(RLN)的保护作用。方法2019年2月~2020年2月我院行复杂甲状腺术病人102例病人,按照入院时间分为两组,其中2019年2月~2019年8月选取的病人为对照组,2019年9月~2020年2月选取的病人为观察组,每组各51例。对照组采用常规RLN暴露联合Miccoli模式下腔镜辅助手术,观察组采用IONM联合Miccoli模式下腔镜辅助手术。比较两组手术时间、出血量、RLN探查时间、引流量和住院时间,对比术后6小时、12小时、24小时视觉模拟评分(VAS评分),并评估术后3个月嗓音障碍指数(VHI评分)及术后喉返神经损伤(RLNI)发生情况。结果观察组出血量(24.20±3.23)ml、引流量(30.52±4.36)ml、住院时间(4.26±0.58)天,对照组分别为(25.12±3.14)ml、引流量(31.10±4.41)ml、住院时间(4.31±0.62)天,两组间比较差异无统计学意义(P>0.05);观察组手术时间为(96.52±11.03)分钟、RLN探查时间为(7.59±1.02)分钟,对照组分别为(141.26±13.47)分钟、(13.10±2.23)分钟,两组比较差异有统计学意义(P<0.05);观察组术后6小时、12小时、24小时VAS评分分别为(4.36±1.07)分、(3.59±0.84)分、(1.89±0.46)分,对照组分别为(4.56±1.18)分、(3.66±0.95)分和(1.93±0.52)分,术后两组VAS评分均呈降低趋势,差异有统计学意义(P<0.05),但两组间VAS评分比较,差异无统计学意义(P>0.05);观察组术后3个月VHI评分为(13.38±2.52)分,对照组为(17.99±3.46)分,两组比较差异有统计学意义(P<0.05);观察组术后RLNI总发生率为3.92%,对照组为17.65%,两组比较差异有统计学意义(P<0.05)。结论IONM在Miccoli腔镜辅助复杂甲状腺术中,能缩短RLN探查时间及手术时间,改善嗓音状况,并降低RLNI发生率。

Objective To study the protective effect of nerve detection technique(IONM)on recurrent laryngeal nerve(RLN)in Miccoli endoscopic assisted complex thyroid surgery.Methods The clinical data of one hundred and two patients who underwent complex thyroidectomy in our hospital from February 2019 to February 2020 were collected retrospectively.They were divided into two groups according to the time of admission,of which the patients selected from February 2019 to August 2019 were the control group and the patients selected from September 2019 to February 2020 were the observation group,with fifty-one cases in each group.The control group was treated with conventional RLN exposure combined with endoscopic assisted surgery in Miccoli mode,and the observation group was treated with endoscopic assisted surgery in IONM combined with Miccoli mode.The operation conditions(operation time,bleeding volume,RLN exploration time,drainage volume and hospital stay)of the two groups were compared,the pain degree[visual analog score(VAS score)]at 6 h,12 h and 24h after operation were compared,and the voice condition[voice disorder index(VHI score)]and the incidence of postoperative recurrent laryngeal nerve injury(RLNi)at 3 months after operation were evaluated.Results The bleeding of observation group was(24.20±3.23)ml,volume of drainage was(30.52±4.36)ml,length of hospital stay was(4.26±0.58)days,while the data in the control group were(25.12±3.14)ml,(31.10±4.41)ml,(4.31±0.62)d,respectively.There was no significant difference between the two groups(P>0.05).The operation time(96.52±11.03)min and RLN exploration time(7.59±1.02)min in the observation group were shorter than those in the control group[(141.26±13.47)min and(13.10±2.23)min,P<0.05].The VAS scores at 6h,12h and 24h in the observation group were(4.36±1.07),(3.59±0.84)and(1.89±0.46),respectively,and the VAS scores at 6h,12h and 24h in the control group were(4.56±1.18),(3.66±0.95)and(1.93±0.52),respectively.The VAS score of the two groups decreased gradually after operation(P<0.05).However,there was no significant difference in VAS score between the two groups(P>0.05).The VHI score of the observation group(13.38±2.52)was lower than that of the control group(17.99±3.46)3 months after operation(P<0.05).The total incidence of RLNi in the observation group was 3.92%,which was lower than the control group(17.65%,P<0.05).Conclusion IONM can shorten the exploration time and operation time of RLN in Miccoli endoscopic assisted complex thyroid surgery,improve the voice condition,reduce the incidence of RLNi,and improve the operation effect.