甲状腺手术中喉返神经术中神经监测的学习曲线
The learning curve for intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery.
作者信息
Wojtczak Beata, Kaliszewski Krzysztof, Sutkowski Krzysztof, Głód Mateusz, Barczyński Marcin
机构信息
Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
出版信息
Langenbecks Arch Surg. 2017 Jun;402(4):701-708. doi: 10.1007/s00423-016-1438-8. Epub 2016 May 13.
PURPOSE
Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) is often used in thyroid surgery. However, this procedure is complex and requires a learning period to master the technique. The aim of the study was to evaluate the learning curve for IONM.
METHODS
A 3-year period (2012-2014) of working with IONM (NIM3.0, Medtronic) was prospectively analyzed with a special emphasis on comparing the initial implementation phase in 2012 (101 patients, 190 RLNs at risk) with subsequent years of IONM use in 2013 (70 patients, 124 RLNs at risk) and 2014 (65 patients, 120 RLNs at risk).
RESULTS
The rate of successful IONM-assisted RLN identification increased gradually over the 3-year study period (92.11 % in 2012 vs. 95.16 % in 2013 vs. 99.16 % in 2014; p = 0.022), with a corresponding decrease in the rate of technical problems (12.87, 4.3, and 4.6 %, respectively; p = 0.039). The rate of RLN injuries tended to decrease over time: 3.68, 1.55, and 0.83 %, respectively (p = 0.220). Between 2012 and 2014, increases in the sensitivity (71.4 vs. 100 %), specificity (98 vs. 99 %), positive predictive value (62.5 vs. 75 %), negative predictive value (98 vs. 100 %), and overall accuracy of IONM (97.4 vs. 99.6 %) were observed (p = 0.049). Increasing experience with IONM resulted in more frequent utilization of total thyroidectomy (92 % in 2012 vs. 100 % in 2013-2014; p = 0.004).
CONCLUSIONS
There was a sharp decrease in the number of technical problems involving equipment setup from 2012 to 2014.
目的
甲状腺手术中常使用喉返神经（RLN）的术中神经监测（IONM）。然而，该操作复杂，需要一段学习期来掌握技术。本研究的目的是评估IONM的学习曲线。
方法
对使用IONM（美敦力NIM3.0）的3年期间（2012 - 2014年）进行前瞻性分析，特别着重比较2012年的初始实施阶段（101例患者，190条有风险的RLN）与2013年（70例患者，124条有风险的RLN）和2014年（65例患者，120条有风险的RLN）后续IONM使用年份的情况。
结果
在3年的研究期间，IONM辅助成功识别RLN的比率逐渐增加（2012年为92.11%，2013年为95.16%，2014年为99.16%；p = 0.022），技术问题发生率相应降低（分别为12.87%、4.3%和4.6%；p = 0.039）。RLN损伤率随时间有下降趋势：分别为3.68%、1.55%和0.83%（p = 0.220）。在2012年至2014年期间，IONM的敏感性（71.4对100%）、特异性（98对99%）、阳性预测值（62.5对75%）、阴性预测值（98对100%）和总体准确性（97.4对99.6%）均有所提高（p = 0.049）。IONM经验的增加导致全甲状腺切除术的使用率更高（2012年为92%，2013 - 2014年为100%；p = 0.004）。
结论
从2012年到2014年，涉及设备设置的技术问题数量急剧减少。
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