Pardal-Refoyo José Luis, Parente-Arias Pablo, Arroyo-Domingo Marta María, Maza-Solano Juan Manuel, Granell-Navarro José, Martínez-Salazar Jesús María, Moreno-Luna Ramón, Vargas-Yglesias Elvylins
Comisión de Cabeza y Cuello y Base de Cráneo (SEORL CCC); SACYL.Complejo Asistencial de Zamora, Zamora, España.
Comisión de Cabeza y Cuello y Base de Cráneo (SEORL CCC); Complexo Hospitalario Universitario de A Coruña, A Coruña, España.
Acta Otorrinolaringol Esp (Engl Ed). 2018 Jul-Aug;69(4):231-242. doi: 10.1016/j.otorri.2017.06.005. Epub 2017 Sep 14.
Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.
To develop a support document for guidance on the use of IONM in TPTS.
Work group consensus through systematic review and the Delphi method.
Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications.
IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.
甲状腺和甲状旁腺手术（TPTS）存在损伤喉返神经、喉上神经及导致声音改变的风险。术中神经监测（IONM），无论是间歇性还是连续性的，都用于评估喉神经的功能状态，且其应用越来越广泛。这意味着有必要就最具争议的方面达成共识。
制定一份关于在TPTS中使用IONM的指导支持文件。
通过系统评价和德尔菲法达成工作组共识。
确定了七个达成共识的方面：适应证、设备、技术（编程和记录参数）、信号丢失时的处理、喉镜检查、声音及法律影响。
IONM有助于定位和识别喉返神经，在其解剖过程中提供帮助，在手术结束时报告其功能状态，并能在计划进行的双侧甲状腺切除术中首次手术侧出现信号丢失或先前对侧麻痹的情况下辅助决策。IONM的准确性取决于诸如技术水平、技术本身以及正确执行技术和解读信号的培训等变量。本文档是未来在每个共识部分就TPTS达成协议的起点。
