Kadakia Sameep, Mourad Moustafa, Hu Shirley, Brown Ryan, Lee Thomas, Ducic Yadranko
New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA.
Oral Maxillofac Surg. 2017 Sep;21(3):335-339. doi: 10.1007/s10006-017-0637-y. Epub 2017 Jun 2.
The efficacy of intraoperative nerve monitoring is controversial in the literature. This study of a single surgeon's experience seeks to determine if the use of intraoperative nerve monitoring influences recurrent laryngeal nerve injury during thyroid surgery.
Six hundred fifty-seven patients with normal pre-operative vocal fold function underwent thyroid surgery without the use of intraoperative nerve monitoring from September 1997 to January 2007, while 761 patients underwent thyroid surgery from February 2007 to February 2016 with routine use of nerve monitoring. Patients were followed for a minimum of 6 months after surgery, and postoperative nerve function was determined by fiberoptic laryngoscopy. A Fisher test was used to determine if nerve injury was statistically different between both groups.
In patients operated on without nerve monitoring, 21 patients were found to have postoperative vocal fold paralysis with nine regaining functioning. In patients operated on with nerve monitoring, 27 were found to have vocal fold dysfunction with 17 regaining function. Fisher test analysis, both with and without patients regaining function, showed no difference in nerve injury between groups (p > 0.05, p > 0.05).
Intraoperative monitoring during thyroidectomy may not prevent injury to the recurrent laryngeal nerve.
术中神经监测的疗效在文献中存在争议。本研究基于一位外科医生的经验，旨在确定术中神经监测的使用是否会影响甲状腺手术期间喉返神经损伤。
1997年9月至2007年1月，657例术前声带功能正常的患者在未使用术中神经监测的情况下接受了甲状腺手术，而2007年2月至2016年2月，761例患者在常规使用神经监测的情况下接受了甲状腺手术。术后对患者进行至少6个月的随访，并通过纤维喉镜检查确定术后神经功能。采用Fisher检验来确定两组之间神经损伤是否存在统计学差异。
在未进行神经监测的手术患者中，发现21例患者术后出现声带麻痹，其中9例恢复了功能。在进行神经监测的手术患者中，发现27例有声带功能障碍，其中17例恢复了功能。Fisher检验分析，无论患者是否恢复功能，两组之间的神经损伤均无差异（p>0.05，p>0.05）。
甲状腺切除术中的术中监测可能无法预防喉返神经损伤。
