神经探测技术在腔镜甲状腺手术中对喉返神经保护的临床研究

Clinical Study of Nerve Probing Technology for Recurrent Laryngeal Nerve Protection in Laparoscopic Thyroid Surgery

目的:探讨腔镜甲状腺手术中实施神经探测技术(Intraoperative Neuromonitoring,IONM)对喉返神经保护的效果。方法:选择2020年1月~2024年4月本院收治的70例甲状腺肿瘤患者,均予以腔镜手术,根据术中是否应用IONM分为两组,对照组未应用IONM,观察组应用IONM,每组35例,对比效果。结果:围术期指标对比,两组术中出血量无差异(P>0.05),但观察组手术时间、术后引流管拔除时间、住院时间更短,术后24h切口引流量更少,与对照组有差异(P<0.05);观察组呼吸困难、吞咽困难、饮水呛咳发生率稍低于对照组,差异无统计学意义(P>0.05),但喉返神经损伤发生率显著低于对照组(P<0.05)。结论:腔镜甲状腺手术中实施IONM辅助手术,可快速识别喉返神经走行、预测变异、保护喉返神经功能完整,从而减少喉返神经损伤发生风险,同时对其他手术并发症也有一定的降低作用,甚至可缩短手术时间、住院时间,术后能更快拔除引流管,减少引流量。

Objective:To investigate the effect of nerve detection technology(IONM)on recurrent laryngeal nerve protection in laparoscopic thyroid surgery.Methods:70 patients with thyroid tumors admitted to our hospital from January 2020 to April 2024 were selected,all of whom underwent laparoscopic surgery.They were divided into two groups based on whether IONM was used during surgery.The control group did not use IONM,while the observation group used IONM,with 35 cases in each group,compared the effects.Results:Comparison of perioperative indicators showed no difference in intraoperative bleeding between the two groups(P>0.05),but the observation group had shorter surgical time,postoperative drainage tube removal time,and hospital stay.The incision drainage flow rate was lower at 24 hours after surgery,which was significantly different from the control group(P<0.05);The incidence of breathing difficulties,swallowing difficulties,and coughing due to drinking water in the observation group was slightly lower than that in the control group,with no statistically significant difference(P>0.05),but the incidence of recurrent laryngeal nerve injury was significantly lower than that in the control group(P<0.05).Conclusion:The implementation of IONM assisted surgery in laparoscopic thyroid surgery can quickly identify the course of the recurrent laryngeal nerve,predict mutations,and protect the integrity of the recurrent laryngeal nerve function,thereby reducing the risk of recurrent laryngeal nerve injury.At the same time,it also has a certain reducing effect on other surgical complications,and can even shorten the surgical time and hospitalization time.After surgery,the drainage tube can be removed more quickly,reducing the drainage volume.