Lee Jane, Fraser Sheila, Glover Anthony, Sidhu Stan
The University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Sydney Medical School Northern, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2017 Oct;87(10):E138-E142. doi: 10.1111/ans.13606. Epub 2016 Apr 18.
The use of routine intraoperative neuromonitoring (IONM) is controversial in thyroid surgery. Guidelines have been published to standardize IONM. This study examines the impact of routine IONM on a high-volume thyroid surgeon.
A prospective study was conducted using IONM between May 2013 and December 2014. Demographics, type of operation, pathology, recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) visualization and sub-type classification, cricothyroid or cricopharyngeal twitch/electrode depolarization were obtained, and complications were recorded. Outcomes were compared with 500 thyroidectomies performed by the same surgeon without neuromonitoring.
Two hundred and ninety-nine total thyroidectomies and 191 hemithyroidectomies were performed with IONM resulting in 789 RLN and 789 EBSLN at risk of injury. Demographics, indication, pathology and complications were similar between the two groups. IONM provided additional information for 58 RLN dissections (7.4%) stratifying surgical decision-making. Loss of signal was detected in 1.8% of nerves at risk. IONM assisted in identification of 109 (13.8%, P < 0.0001) EBSLN, including a 15.8% improvement in identifying type 2b EBSLN. Utility of IONM was not predicted by surgery indication; however, multinodular goitre was a significant predictor of IONM assisted identification of type 2b EBSLN (OR = 2.24, P = 0.01).
Routine IONM provides intraoperative information to a high-volume thyroid surgeon regarding the recurrent and external nerves over and above direct visualization alone, and its utility could not be predicted by operative indication.
术中常规神经监测（IONM）在甲状腺手术中的应用存在争议。已发布指南以规范IONM。本研究探讨常规IONM对一位高手术量甲状腺外科医生的影响。
于2013年5月至2014年12月期间使用IONM进行了一项前瞻性研究。获取了人口统计学资料、手术类型、病理、喉返神经（RLN）和喉上神经外支（EBSLN）的可视化及亚型分类、环甲肌或环咽肌抽搐/电极去极化情况，并记录了并发症。将结果与同一位外科医生进行的500例未行神经监测的甲状腺切除术进行比较。
使用IONM进行了299例全甲状腺切除术和191例半甲状腺切除术，导致789条RLN和789条EBSLN有损伤风险。两组之间的人口统计学资料、手术指征、病理和并发症相似。IONM为58例RLN解剖（7.4%）提供了额外信息，有助于分层手术决策。在1.8%的有风险神经中检测到信号丢失。IONM协助识别了109条（13.8%，P<0.0001）EBSLN，包括在识别2b型EBSLN方面有15.8%的改善。手术指征无法预测IONM的效用；然而，结节性甲状腺肿是IONM协助识别2b型EBSLN的重要预测因素（OR=2.24，P=0.01）。
常规IONM为高手术量甲状腺外科医生提供了关于喉返神经和喉上神经外支的术中信息，这些信息超出了单纯直接可视化所能提供的范围，并且其效用无法通过手术指征来预测。
