Fontenot Tatyana E, Randolph Gregory W, Setton Tedhar E, Alsaleh Nuha, Kandil Emad
Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, U.S.A.
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
Laryngoscope. 2015 Sep;125(9):2232-5. doi: 10.1002/lary.25133. Epub 2015 Jan 19.
OBJECTIVES/HYPOTHESIS: Demonstrate whether intraoperative nerve monitoring is an effective tool in staging bilateral thyroid and neck surgeries in cases of intraoperative injury to the recurrent laryngeal nerve on the side of initial dissection. We hypothesized that IONM provides reliable and appropriate feedback on the functional status of the RLN on side of initial dissection during total thyroidectomy and central neck surgery.
Case series with planned data collection.
All patients receiving total thyroidectomies or central neck surgeries were reviewed. The outcomes of patients treated whose procedures were staged based on intraoperative nerve monitoring are described.
Ten (4.9%) of 206 procedures were staged based on unfavorable signal change including six patients with thyroid cancers and four with compressive substernal goiters. The overall signal drop in the 10 patients with unfavorable signal change was 63%. Three patients had complete loss of signal. In the other seven patients, the signal dropped by a mean of 48%. In the eight patients with laryngoscopy-proven vocal fold paresis, the signal dropped by a mean of 68%.
Intraoperative nerve monitoring results accurately indicated postoperative ipsilateral vocal cord dysfunction with high reliability. Intraoperative nerve monitoring is a reliable tool in staging thyroid surgery.
目的/假设：证明术中神经监测在双侧甲状腺及颈部手术中，对于初次解剖侧喉返神经术中损伤的分期是否为有效工具。我们假设术中神经监测能在全甲状腺切除术及中央区颈部手术期间，就初次解剖侧喉返神经的功能状态提供可靠且恰当的反馈。
带有计划数据收集的病例系列。
回顾了所有接受全甲状腺切除术或中央区颈部手术的患者。描述了基于术中神经监测进行分期治疗的患者的结果。
206例手术中有10例（4.9%）基于不良信号变化进行了分期，其中包括6例甲状腺癌患者和4例胸骨后压迫性甲状腺肿患者。10例有不良信号变化的患者的总体信号下降为63%。3例患者信号完全丧失。在其他7例患者中，信号平均下降48%。在8例经喉镜证实声带麻痹的患者中，信号平均下降68%。
术中神经监测结果能高度可靠地准确显示术后同侧声带功能障碍。术中神经监测是甲状腺手术分期的可靠工具。
4级。
