喉返神经术中神经监测的经验可提高未进行监测的甲状腺切除术的手术技巧和手术效果。
Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy.
作者信息
Wojtczak Beata, Sutkowski Krzysztof, Kaliszewski Krzysztof, Głód Mateusz, Barczyński Marcin
机构信息
Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, M.C. Sklodowskiej 66, 50-369, Wrocław, 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):709-717. doi: 10.1007/s00423-016-1449-5. Epub 2016 May 21.
PURPOSE
Intraoperative neuromonitoring (IONM) can serve as a tool to increase skills in recurrent laryngeal nerve (RLN) identification and complete removal of thyroid tissue. The aim of this study was to validate this hypothesis.
METHODS
This prospective study involved 632 patients (1161 RLNs at risk) who underwent thyroid surgery in 2011-2014. Although IONM was not used until 2012, this prospective study started on 1 January 2011. The three participating surgeons knew about the study before that date and that the rate of RLN identification would be carefully measured in total and near-total surgery. Solely, visual identification of the RLN was used throughout 2011. IONM was introduced as a training tool in 2012-2014 for the first 3 months of each year. In the remaining months, thyroid operations were performed without IONM. Outcomes of non-monitored thyroid operations were compared before (01-12/2011) vs. after (04-12/2012-2014) 3 months of exposure to IONM yearly (01-03/2012-2014). The rate of RLN identification was assessed in total and near-total thyroidectomies and in totally resected lobes in Dunhill's operation. The prevalence of RLN injury and the utilization of total thyroidectomy were evaluated.
RESULTS
In 2011, the rate of successful RLN visual identification in total and near-total thyroidectomies and in totally resected lobes in Dunhill's operation was 45.71 %. After the introduction of IONM in 2012-2014, in the procedures performed without IONM, the rate was 86.66, 90.81, and 91.3 %. The prevalence of RLN injury in 2011 was 6.8 %, while in the years following the introduction of IONM, it was 3.61, 2.65, and 1.45 %. Utilization of total thyroidectomy increased from 47.9 % in 2011 to 100 % in 2014.
CONCLUSIONS
Experience with IONM led to an increase in RLN identification (p < 0.0001), a decrease of RLN injury (p < 0.05), and an increase in the safe utilization of total thyroidectomy (p < 0.0001) in non-monitored thyroid operations. IONM is a valuable tool for surgical training.
目的
术中神经监测（IONM）可作为一种提高喉返神经（RLN）识别技能及甲状腺组织完整切除率的工具。本研究旨在验证这一假设。
方法
这项前瞻性研究纳入了2011年至2014年接受甲状腺手术的632例患者（1161条喉返神经存在风险）。尽管IONM直到2012年才开始使用，但这项前瞻性研究于2011年1月1日启动。三位参与手术的外科医生在该日期之前就知晓这项研究，并且在全甲状腺切除和近全甲状腺切除手术中会仔细测量喉返神经的识别率。在2011年全年仅依靠视觉识别喉返神经。在2012年至2014年每年的前3个月将IONM作为一种训练工具引入。在其余月份，甲状腺手术不使用IONM。比较每年接触IONM 3个月之前（2011年1月至12月）与之后（2012年4月至2014年12月）未进行监测的甲状腺手术的结果。在全甲状腺切除和近全甲状腺切除以及邓希尔手术中完全切除的叶中评估喉返神经的识别率。评估喉返神经损伤的发生率以及全甲状腺切除术的使用率。
结果
2011年，在全甲状腺切除和近全甲状腺切除以及邓希尔手术中完全切除的叶中，喉返神经视觉识别成功率为45.71%。在2012年至2014年引入IONM后，在未使用IONM的手术中，该识别率分别为86.66%、90.81%和91.3%。2011年喉返神经损伤的发生率为6.8%，而在引入IONM后的几年中，分别为3.61%、2.65%和1.45%。全甲状腺切除术的使用率从2011年的47.9%增加到2014年的100%。
结论
IONM的使用经验导致在未进行监测的甲状腺手术中，喉返神经识别率提高（p<0.0001），喉返神经损伤减少（p<0.05），全甲状腺切除术的安全使用率增加（p<0.0001）。IONM是手术训练的一种有价值的工具。
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