Pavier Yoann, Saroul Nicolas, Pereira Bruno, Tauveron Igor, Gilain Laurent, Mom Thierry
Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Gabriel Montpied, CHU, Clermont-Ferrand, France.
Délégation Recherche Clinique and Innovation, Villa annexe IFSI, Hopital Gabriel Montpied, CHU, Clermont-Ferrand, France.
Head Neck. 2015 Jun;37(6):835-9. doi: 10.1002/hed.23676. Epub 2014 May 2.
The purpose of this study was to evaluate the contribution of laryngeal intraoperative nerve monitoring (IONM) during thyroidectomy in predicting postoperative laryngeal mobility.
Between 2009 and 2012, 127 patients underwent thyroidectomy, during which 216 recurrent laryngeal nerves were stimulated with suprathreshold stimulations. Laryngeal mobility was examined through direct laryngoscopy. Statistical analysis was performed to determine specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and a threshold value in order to define a intraoperative diagnostic test.
Nine patients had a unilateral laryngeal palsy. No bilateral laryngeal palsy was observed. The threshold value to assure the postoperative laryngeal mobility is 280 μV. For this value, specificity was 94.06%, sensitivity 100%, NPV 100%, and PPV 47.83%.
Laryngeal IONM can predict a favorable outcome of laryngeal mobility in cases in which the response exceeds 280 μV. Under this value, the risk of palsy is about 50% suggesting a staged surgery.
本研究的目的是评估甲状腺切除术中喉返神经术中神经监测（IONM）对预测术后喉活动度的作用。
2009年至2012年间，127例患者接受了甲状腺切除术，术中用阈上刺激刺激了216条喉返神经。通过直接喉镜检查评估喉活动度。进行统计分析以确定特异性、敏感性、阴性预测值（NPV）、阳性预测值（PPV）以及用于定义术中诊断试验的阈值。
9例患者出现单侧喉麻痹。未观察到双侧喉麻痹。确保术后喉活动度的阈值为280μV。对于该值，特异性为94.06%，敏感性为100%，NPV为100%，PPV为47.83%。
当喉返神经术中神经监测反应超过280μV时，可预测喉活动度良好。低于该值时，麻痹风险约为50%，提示分期手术。
