Lifante Jean-Christophe, McGill Julie, Murry Thomas, Aviv Jonathan E, Inabnet William B
Department of Surgery, Division of Endocrine and GI Surgery, Columbia University, New York, New York, USA.
Surgery. 2009 Dec;146(6):1167-73. doi: 10.1016/j.surg.2009.09.023.
The aim of this study was to assess the impact of the neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) on the voice quality after mini-incision thyroidectomy under local/regional anesthesia and intravenous sedation.
Patients undergoing mini-incision thyroidectomy under local anesthesia were prospectively randomized for either nerve monitoring of the EBSLN (group 1) or no nerve monitoring (group 2). Voice and swallowing assessment were obtained by using the Voice Handicap Index-10 (VHI-10) and the Reflux Symptom Index questionnaires (RSI) before surgery and at 3 weeks and 3 months after surgery.
Recruitment led to 22 patients in group 1 and 25 patients in group 2. The rate of visualized EBSLN was higher in group 1 (66% vs 21%; P = .003). Contrary to group 1, in group 2, the median total VHI-10 score was significantly higher 3 months after surgery (P = .034) compared with preoperatively, indicating a subjective voice handicap. In both groups, there was no difference in median total RSI score before surgery or at 3 weeks and 3 months after surgery.
Nerve monitoring aids in the visualization of the EBSLN during mini-incision thyroidectomy under local/regional anesthesia and leads to an improvement in patient-assessed voice quality after surgery but does not impact swallowing.
本研究的目的是评估在局部/区域麻醉和静脉镇静下，喉上神经外支（EBSLN）神经监测对小切口甲状腺切除术后嗓音质量的影响。
前瞻性随机选取在局部麻醉下接受小切口甲状腺切除术的患者，分为EBSLN神经监测组（第1组）和无神经监测组（第2组）。术前、术后3周和3个月，使用嗓音障碍指数-10（VHI-10）和反流症状指数问卷（RSI）对嗓音和吞咽功能进行评估。
第1组纳入22例患者，第2组纳入25例患者。第1组EBSLN可视化率更高（66%对21%；P = 0.003）。与第1组相反，在第2组中，术后3个月的VHI-10总分中位数较术前显著升高（P = 0.034），表明存在主观嗓音障碍。两组术前及术后3周和3个月的RSI总分中位数均无差异。
在局部/区域麻醉下的小切口甲状腺切除术中，神经监测有助于EBSLN的可视化，并可改善患者术后自我评估的嗓音质量，但不影响吞咽功能。
