Wojtczak Beata, Barczyński Marcin
1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Gland Surg. 2016 Oct;5(5):481-489. doi: 10.21037/gs.2016.09.07.
Reoperative thyroid surgery is still challenging even for skilled surgeons, and is associated with a higher incidence of complications, such as hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Displacement of the RLN, scar tissue from previous neck surgery and difficulty in maintaining good hemostasis are risk factors in reoperations. The prevalence of RLN injury in reoperative thyroid surgery ranges as high as 12.5% for transient injury and up to 3.8% for permanent injury. Bilateral paresis can also occur during reoperations, and is a dangerous complication influencing the quality of life, sometimes requiring tracheostomy. RLN identification is the gold standard during thyroidectomy, and the use of intraoperative neuromonitoring (IONM) can be a valuable adjunct to visual identification. This technique can be used to identify the RLN and the external branch of the superior laryngeal nerve (EBSLN), both of which are standardized procedures. The aim of this review was to evaluate the use of intermittent neural monitoring of the RLN in surgery for recurrent goiter, and to assess the prevalence of RLN injury while using IONM reported in the current literature.
再次甲状腺手术即使对于经验丰富的外科医生来说仍然具有挑战性，并且与较高的并发症发生率相关，如甲状旁腺功能减退和喉返神经（RLN）麻痹。喉返神经移位、既往颈部手术的瘢痕组织以及难以维持良好的止血是再次手术的危险因素。再次甲状腺手术中喉返神经损伤的发生率，短暂性损伤高达12.5%，永久性损伤高达3.8%。双侧麻痹在再次手术中也可能发生，是一种影响生活质量的危险并发症，有时需要气管切开术。喉返神经识别是甲状腺切除术中的金标准，术中神经监测（IONM）的应用可以成为视觉识别的有价值辅助手段。该技术可用于识别喉返神经和喉上神经外支（EBSLN），这两种识别都是标准化程序。本综述的目的是评估在复发性甲状腺肿手术中对喉返神经进行间歇性神经监测的应用，并评估当前文献中报道的使用术中神经监测时喉返神经损伤的发生率。
