Chan Wai-Fan, Lo Chung-Yau
Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
World J Surg. 2006 May;30(5):806-12. doi: 10.1007/s00268-005-0355-8.
Intraoperative neuromonitoring has been widely adopted to facilitate the identification and preservation of recurrent laryngeal nerve (RLN) function during thyroid surgery. The present prospective study validated the ability of this technique to predict postoperative RLN outcomes in a single endocrine surgical unit.
Neuromonitoring was performed using Neurosign 100 with laryngeal surface electrodes in 171 patients with 271 nerves at risk during thyroidectomy. Vocal cord function was routinely documented perioperatively. Patients were also stratified to low risk (primary surgery for benign disease) and high risk (malignancy and recurrent disease) for subgroup analysis.
Unilateral vocal cord palsy occurred in 15 patients (5.5%) postoperatively. The incidence of postoperative nerve palsy in the low risk and high risk groups was 4.4% and 7.8%, respectively. All but two patients had recovery of function within a median period of 4 months after the operation. The rates of transient and permanent RLN palsy based on nerves at risk were 4.8% (n = 13) and 0.7% (n = 2), respectively. There were 241 true-negative (positive signal and no cord palsy), 15 false-positive (negative signal but no cord palsy), 8 true-positive (negative signal and cord palsy), and 7 false-negative (positive signal but cord palsy) results, as correlated with the postoperative assessment. The sensitivity, specificity, and positive and negative predictive values were 53%, 94%, 35%, and 97%, respectively. For the high risk group, the sensitivity and positive predictive value increased to 86% and 60%, respectively.
There are pitfalls associated with the use of intraoperative neuromonitoring during thyroid surgery. Routine application is not recommended except for selected high risk patients.
术中神经监测已被广泛应用于甲状腺手术中，以帮助识别和保留喉返神经（RLN）功能。本前瞻性研究验证了该技术在单个内分泌外科单元中预测术后RLN结果的能力。
在171例甲状腺切除术中271条神经有风险的患者中，使用带有喉表面电极的Neurosign 100进行神经监测。围手术期常规记录声带功能。患者还被分为低风险组（良性疾病的初次手术）和高风险组（恶性肿瘤和复发性疾病）进行亚组分析。
术后15例患者（5.5%）出现单侧声带麻痹。低风险组和高风险组术后神经麻痹的发生率分别为4.4%和7.8%。除2例患者外，所有患者在术后中位4个月内功能恢复。基于有风险的神经，短暂性和永久性RLN麻痹的发生率分别为4.8%（n = 13）和0.7%（n = 2）。与术后评估相关的结果有241例假阴性（阳性信号且无声带麻痹）、15例假阳性（阴性信号但无声带麻痹）、8例真阳性（阴性信号且声带麻痹）和7例假阴性（阳性信号但声带麻痹）。敏感性、特异性、阳性预测值和阴性预测值分别为53%、94%、35%和97%。对于高风险组，敏感性和阳性预测值分别提高到86%和60%。
甲状腺手术中使用术中神经监测存在一些缺陷。除了选定的高风险患者外，不建议常规应用。
