Wang Yong, Yu Xing, Wang Ping, Miao Chundi, Xie Qiuping, Yan Haichao, Zhao Qunzi, Zhang Maolin, Xiang Cheng
Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
J Laparoendosc Adv Surg Tech A. 2016 Dec;26(12):965-971. doi: 10.1089/lap.2016.0291. Epub 2016 Sep 1.
Transoral endoscopic approach is the natural orifice surgery applied in thyroidectomy to achieve an excellent cosmetic result. Recurrent laryngeal nerve (RLN) injury is the most common complication and little advancement was achieved in the previous clinical studies of transoral thyroid surgery. Herein, we introduced the method of intraoperative neuromonitoring (IONM) for transoral endoscopic thyroid surgery.
Patients with thyroid carcinoma received transoral endoscopic thyroid surgery through vestibular approach (TOETVA) for thyroidectomy and central node dissection (CND). IONM was implemented to identify whether the RLN benefited from oral tracheal intubation. The laryngeal electromyography (EMG) response, operation time, number of CND, drainage volume, hospital duration, surgical complications, and cosmetic results were evaluated.
From August to October 2015, 10 cases were performed with TOETVA and IONM. All EMG responses were recorded intraoperatively, and no case experienced transient or permanent RLN palsy. The operation time ranged from 130 to 215 minutes in ipsilateral lobectomy with CND, whereas bilateral lobectomy with ipsilateral CND lasted 345 minutes. The number of CNDs ranged from three to eight. The average time of drainage extubation and discharge was 4 days (3-5 days) postoperatively. All patients were satisfied with the cosmetic results, and no infection was observed at lip wound or in the anterior neck region.
IONM system implemented in transoral thyroid surgery was feasible and serviceable in preventing RLN injury. The method of TOETVA shows promise for thyroidectomy with CND due its ideal cosmetic results.
经口内镜入路是应用于甲状腺切除术中以获得极佳美容效果的自然腔道手术。喉返神经（RLN）损伤是最常见的并发症，并且在以往经口甲状腺手术的临床研究中进展甚微。在此，我们介绍了经口内镜甲状腺手术术中神经监测（IONM）的方法。
甲状腺癌患者接受经口内镜甲状腺手术，通过前庭入路（TOETVA）进行甲状腺切除及中央区淋巴结清扫（CND）。实施IONM以确定喉返神经是否受益于经口气管插管。评估喉肌电图（EMG）反应、手术时间、CND数量、引流量、住院时间、手术并发症及美容效果。
2015年8月至10月，对10例患者实施了TOETVA及IONM。术中记录了所有EMG反应，无一例出现喉返神经短暂或永久性麻痹。同侧叶切除加CND的手术时间为130至215分钟，而双侧叶切除加同侧CND持续345分钟。CND数量为3至8个。术后引流管拔除及出院的平均时间为4天（3至5天）。所有患者对美容效果满意，唇部伤口或颈前区均未观察到感染。
经口甲状腺手术中实施的IONM系统在预防喉返神经损伤方面是可行且有效的。TOETVA方法因其理想的美容效果，在甲状腺切除加CND方面显示出前景。
