Rybakovas Andrius, Bausys Augustinas, Matulevicius Andrius, Zaldokas Gytis, Kvietkauskas Mindaugas, Tamulevicius Gintautas, Beisa Virgilijus, Strupas Kestutis
Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Center of Ear, Nose and Throat, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
Wideochir Inne Tech Maloinwazyjne. 2019 Jan;14(1):38-45. doi: 10.5114/wiitm.2018.80066. Epub 2018 Dec 10.
Recurrent laryngeal nerve injury is one of the major complications related to thyroid surgery. Intraoperative recurrent laryngeal nerve functional status monitoring is becoming a standard part of thyroid surgery. However, the current methods for intraoperative nerve functional status assessment are associated with a demand for specialized devices and increased costs.
To assess the validity of a new method - intraoperative laryngeal ultrasonography - for prediction of recurrent laryngeal nerve injury.
This prospective diagnostic test accuracy study included 112 patients undergoing thyroid surgery in Vilnius University Hospital Santaros Clinics. Neurostimulation combined with laryngeal ultrasonography and laryngeal palpation was performed intraoperatively to evaluate recurrent laryngeal nerve functional status. Recurrent laryngeal nerve injury was confirmed by laryngoscopy, which was performed on the first postoperative day and considered to be the gold standard method.
Data on 112 consecutive patients and 200 nerves at risk were collected. The temporary vocal cord palsy rate was 5.4% per patient and 3% per nerve at risk. No permanent palsy or bilateral injury cases were registered in the study cohort. Laryngeal ultrasound sensitivity counted per nerve at risk was 83.3%, specificity 97.2%, accuracy 96.4%, positive predictive value 62.5% and negative predictive value 99%.
Laryngeal ultrasonography is a feasible new technique for accurate intraoperative recurrent laryngeal nerve injury evaluation.
喉返神经损伤是甲状腺手术相关的主要并发症之一。术中喉返神经功能状态监测正成为甲状腺手术的标准组成部分。然而，目前术中神经功能状态评估方法需要专门设备且成本增加。
评估一种新方法——术中喉部超声检查——预测喉返神经损伤的有效性。
这项前瞻性诊断试验准确性研究纳入了维尔纽斯大学医院圣塔罗斯诊所112例接受甲状腺手术的患者。术中进行神经刺激联合喉部超声检查及喉部触诊以评估喉返神经功能状态。术后第一天通过喉镜检查确认喉返神经损伤，喉镜检查被视为金标准方法。
收集了112例连续患者及200条有风险神经的数据。患者的暂时性声带麻痹发生率为5.4%，有风险神经的发生率为3%。研究队列中未记录到永久性麻痹或双侧损伤病例。按有风险神经计算，喉部超声的敏感性为83.3%，特异性为97.2%，准确性为96.4%，阳性预测值为62.5%，阴性预测值为99%。
喉部超声检查是一种可行的新技术，可准确评估术中喉返神经损伤情况。
