Horne Stefanie K, Gal Thomas J, Brennan Joseph A
Department of Otolaryngology, Wilford Hall Medical Center, Lackland AFB, TX, USA.
Otolaryngol Head Neck Surg. 2007 Jun;136(6):952-6. doi: 10.1016/j.otohns.2007.02.011.
To estimate the patterns of use of intraoperative recurrent laryngeal nerve (RLN)-monitoring devices during thyroid surgery by otolaryngologists in the United States.
A questionnaire was mailed to 1685 randomly selected otolaryngologists, representing approximately half of all otolaryngologists currently practicing in the United States. Topics covered included training history and current practice setting, use and characteristics of use of RLN monitoring during thyroid surgery, as well as history of RLN injury and/or subsequent lawsuits. chi(2) test was used to examine associations between monitor usage and dependent variables, and odds ratios calculated by logistic regression were used to refine the magnitude of these associations.
A total of 685 (40.7%) of questionnaires were returned, and 81 percent (555) of respondents reported performing thyroidectomy. Of those, only 28.6 percent (159) reported using intraoperative monitoring for all cases. Respondents were 3.14 times more likely to currently use intraoperative monitoring if they used it during their training. Surgeons currently using intraoperative RLN monitoring during thyroidectomy were 41 percent less likely to report a history of permanent RLN injury. Further information about surgeon background and rationale for decisions regarding RLN monitor usage are discussed.
Presently, the majority of otolaryngologists in the United States do not report regular usage of RLN monitoring in their practices. Surgeon background and training, more so than surgical volume, significantly influenced the use of intraoperative RLN monitoring.
评估美国耳鼻喉科医生在甲状腺手术中使用术中喉返神经（RLN）监测设备的模式。
向1685名随机选取的耳鼻喉科医生邮寄了调查问卷，这些医生约占美国目前执业耳鼻喉科医生总数的一半。涵盖的主题包括培训经历和当前执业环境、甲状腺手术中RLN监测的使用情况及使用特点，以及RLN损伤史和/或后续诉讼情况。采用卡方检验来检验监测设备使用情况与因变量之间的关联，并使用逻辑回归计算的优势比来细化这些关联的程度。
共收回685份问卷（40.7%），81%（555名）的受访者报告进行过甲状腺切除术。其中，只有28.6%（159名）报告在所有病例中都使用术中监测。如果受访者在培训期间使用过术中监测，那么他们目前使用术中监测的可能性要高3.14倍。目前在甲状腺切除术中使用术中RLN监测的外科医生报告永久性RLN损伤史的可能性要低41%。还讨论了关于外科医生背景以及RLN监测设备使用决策依据的更多信息。
目前，美国大多数耳鼻喉科医生在其执业中并未报告常规使用RLN监测。外科医生的背景和培训，而非手术量，对术中RLN监测的使用有显著影响。
