Ghani Usman, Assad Salman, Assad Shuja
Department of Medicine, Shifa International Hospital, Islamabad, Pakistan.
Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Cureus. 2016 Nov 15;8(11):e880. doi: 10.7759/cureus.880.
Injury to the recurrent laryngeal nerve (RLN) is a well known, though less frequent, complication of parathyroid surgery. In recent years, the use of intraoperative nerve monitoring (IONM) has gained popularity amongst surgeons when operating on thyroid gland; however, its utilization in parathyroid surgery is not established. This trend continues to rise, despite multiple studies documenting no statistically significant difference that IONM decreases the incidence of RLN injury. Most surgeons use this technology as an adjunct to visualization alone for identification of RLN. The purpose of this review is to discuss the possible role of IONM in parathyroid surgery with regards to the accuracy, efficacy, and recent trends in the utilization of this technology. There is insufficient evidence that IONM reduces the risk of RLN injury in parathyroidectomy. Although IONM may decrease the likelihood of nerve injury by helping to identify and map the RLN during thyroidectomy, we did not find studies exclusive to parathyroid surgery to see if its use can be supported for parathyroidectomy. Despite this lack of evidence, we believe that IONM is a promising adjunct to visualization alone in detecting nerve structures during neck dissection, but more clinical trials are warranted to establish its role in preventing nerve injury in parathyroid surgery.
喉返神经（RLN）损伤是甲状旁腺手术中一种众所周知但较少见的并发症。近年来，术中神经监测（IONM）在甲状腺手术中受到外科医生的广泛欢迎；然而，其在甲状旁腺手术中的应用尚未确立。尽管多项研究表明IONM并未降低RLN损伤的发生率，但这种趋势仍在持续上升。大多数外科医生将这项技术仅作为可视化的辅助手段来识别RLN。本综述的目的是讨论IONM在甲状旁腺手术中关于该技术应用的准确性、有效性及近期趋势方面可能发挥的作用。目前尚无充分证据表明IONM能降低甲状旁腺切除术中RLN损伤的风险。虽然IONM可能通过在甲状腺切除术中帮助识别和标记RLN来降低神经损伤的可能性，但我们未找到专门针对甲状旁腺手术的研究来确定其在甲状旁腺切除术中的应用是否能得到支持。尽管缺乏证据，但我们认为IONM在颈部解剖过程中检测神经结构时是一种有前景的可视化辅助手段，但仍需要更多临床试验来确定其在预防甲状旁腺手术中神经损伤方面的作用。
