Otto Randal A, Cochran C Spencer
Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
Ann Otol Rhinol Laryngol. 2002 Nov;111(11):1005-7. doi: 10.1177/000348940211101110.
Bilateral recurrent laryngeal nerve (RLN) paralysis after thyroidectomy is infrequent, but serious when it occurs. Intraoperative knowledge of the status of the nerve after dissection could potentially provide the surgeon with important decision-making information. The current study examines the sensitivity and specificity of intraoperative stimulation of the RLN during thyroid surgery for predicting postoperative RLN deficits. Eighty-one RLNs in 55 patients were identified to be at risk of injury during thyroidectomy or parathyroidectomy performed between January 1998 and February 2000. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator (Xomed, Jacksonville, Florida) set at 0.5 mA. Injury was assessed by palpating for a contraction of the posterior cricoarytenoid muscle while the stimulus was applied. Postoperative assessment of RLN integrity was determined by using indirect or direct laryngoscopy to visualize vocal fold mobility. Nine RLNs failed to elicit a posterior cricoarytenoid contraction after nerve stimulation, and 4 RLNs were determined to be deficient in the postoperative evaluation. The calculated sensitivity and specificity were 75% and 92.2% with a positive predictive value of 33.3% and negative predictive value of 98.6%. The RLN injury rate was 4.94%. We conclude that intraoperative RLN stimulation is a relatively safe and useful method of determining what RLN function will be after thyroid or parathyroid surgery.
甲状腺切除术后双侧喉返神经（RLN）麻痹并不常见，但一旦发生则较为严重。术中了解神经在解剖后的状态可能会为外科医生提供重要的决策信息。本研究旨在探讨甲状腺手术中对喉返神经进行术中刺激以预测术后喉返神经功能缺损的敏感性和特异性。在1998年1月至2000年2月期间进行的甲状腺切除术或甲状旁腺切除术中，55例患者的81条喉返神经被确定有损伤风险。使用设置为0.5毫安的一次性神经刺激器（Xomed，佛罗里达州杰克逊维尔）评估术中喉返神经功能。在施加刺激时，通过触诊环杓后肌的收缩来评估损伤情况。术后通过间接或直接喉镜检查观察声带活动度来确定喉返神经的完整性。9条喉返神经在神经刺激后未引起环杓后肌收缩，4条喉返神经在术后评估中被确定功能缺损。计算得出的敏感性和特异性分别为75%和92.2%，阳性预测值为33.3%，阴性预测值为98.6%。喉返神经损伤率为4.94%。我们得出结论，术中喉返神经刺激是一种相对安全且有用的方法，可用于确定甲状腺或甲状旁腺手术后喉返神经的功能。
