Calò P G, Pisano G, Medas F, Tatti A, Pittau M R, Demontis R, Favoriti P, Nicolosi A
Departments of Surgical Sciences, and School of Specialty in Forensic Medicine, and Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.
Clin Ter. 2013 May-Jun;164(3):e193-8. doi: 10.7417/CT.2013.1567.
The aim of this study was to evaluate the ability of intraoperative recurrent laryngeal nerve monitoring to predict the postoperative functional outcome and the potential role of this technique in reducing the postoperative nerve palsy rate.
Between June 2007 and December 2011, 1693 consecutive patients who underwent thyroidectomy by a single surgical team were evaluated. We compared patients who have had a neuromonitoring and patients who have undergone surgery with the only visualization. Patients in which NIM was not utilized (Group A) were 942 against the others 751 (group B).
In group A there were 28 recurrent laryngeal nerve injuries (2.97%) of which 21 were transients (2.22%) and 7 were permanents (0.74%). In group B there were 20 recurrent laryngeal nerve injuries (2.66%) of which 14 (1.86%) transients and 6 (0.8%) permanents. Differences between the two groups were not statistically significative.
The technique of intraoperative neuromonitoring in thyroid surgery is safe and reliable in excluding postoperative recurrent laryngeal nerve palsy; it has high accuracy, specificity, sensitivity and negative predictive value. Neuromonitoring is useful to identify the recurrent laryngeal nerve and it can be a useful adjunctive technique for reassuring surgeons of the functional integrity of the nerve but it does not decrease the incidence of injuries compared with visualization alone. Its application can be particularly recommended for high-risk thyroidectomies.
本研究旨在评估术中喉返神经监测预测术后功能结局的能力，以及该技术在降低术后神经麻痹发生率方面的潜在作用。
2007年6月至2011年12月期间，对由单一手术团队进行甲状腺切除术的1693例连续患者进行了评估。我们比较了接受神经监测的患者和仅通过可视化进行手术的患者。未使用神经完整性监测（NIM）的患者为942例（A组），其余751例为另一组（B组）。
A组有28例喉返神经损伤（2.97%），其中21例为暂时性损伤（2.22%），7例为永久性损伤（0.74%）。B组有20例喉返神经损伤（2.66%），其中14例（1.86%）为暂时性损伤，6例（0.8%）为永久性损伤。两组之间的差异无统计学意义。
甲状腺手术中术中神经监测技术在排除术后喉返神经麻痹方面是安全可靠的；它具有高准确性、特异性、敏感性和阴性预测值。神经监测有助于识别喉返神经，对于让外科医生放心神经功能完整性而言，它可能是一种有用的辅助技术，但与单纯可视化相比，它并不能降低损伤发生率。特别推荐将其应用于高风险甲状腺切除术。
