Hamilton N, Morley H, Haywood M, Arman S, Mochloulis G
Lister Hospital , Stevenage , UK.
UCL Ear Institute , London , UK.
Ann R Coll Surg Engl. 2019 Jul;101(6):432-435. doi: 10.1308/rcsann.2019.0053. Epub 2019 Jun 3.
Automatic periodic stimulation of the vagal nerve during thyroidectomy provides real-time feedback of recurrent laryngeal nerve function intraoperatively. To assess the validity of this device, the ability of monitoring to predict recurrent laryngeal nerve palsy was determined and the incidence of recurrent laryngeal nerve palsy recorded.
All thyroidectomies using APS® (Automatic Periodic Stimulation, Medtronic) nerve monitoring were reviewed over a 27-month period. Changes in signal amplitude and latency during thyroidectomy were recorded from saved data. Postoperative fibreoptic laryngoscopy determined the incidence of vocal cord immobility and recovery of nerve function was assessed from follow-up letters.
A total of 256 at-risk nerves were examined (132 hemi- and 62 total thyroidectomies) in cases involving benign and malignant disease. Permanent recurrent laryngeal nerve palsy occurred in six (2.3%) lobectomies and transient recurrent laryngeal nerve palsy occurred in two lobectomies (< 1%). Sensitivity for detecting postoperative vocal cord immobility was 100% and specificity 85% if the end amplitude was 50% below baseline. The positive predictive value when amplitude was 50% below baseline was 18%. The negative predictive value when amplitude was 50% above or equal to baseline was 100%. Intraoperatively, the amplitude was 50% below baseline more frequently in the vocal cord immobility group (t-test, < 0.015). No vagal nerve complications occurred.
Whilst the incidence of recurrent laryngeal nerve palsy is comparable to rates in the literature, the incidence of transient palsy is lower than published averages. APS is able to reliably predict recurrent laryngeal nerve palsy based on end amplitude.
甲状腺切除术中对迷走神经进行自动周期性刺激可在术中提供喉返神经功能的实时反馈。为评估该设备的有效性，确定了监测预测喉返神经麻痹的能力，并记录了喉返神经麻痹的发生率。
回顾了在27个月期间所有使用APS®（自动周期性刺激，美敦力公司）神经监测进行的甲状腺切除术。从保存的数据中记录甲状腺切除术中信号幅度和潜伏期的变化。术后纤维喉镜检查确定声带固定的发生率，并通过随访信件评估神经功能的恢复情况。
在涉及良性和恶性疾病的病例中，共检查了256条有风险的神经（132例半甲状腺切除术和62例全甲状腺切除术）。6例（2.3%）叶切除术发生永久性喉返神经麻痹，2例叶切除术发生短暂性喉返神经麻痹（<1%）。如果终末幅度比基线低50%，检测术后声带固定的敏感性为100%，特异性为85%。当幅度比基线低50%时，阳性预测值为18%。当幅度比基线高50%或等于基线时，阴性预测值为100%。术中，声带固定组中幅度比基线低50%的情况更频繁（t检验，<0.015）。未发生迷走神经并发症。
虽然喉返神经麻痹的发生率与文献报道相当，但短暂性麻痹的发生率低于已公布的平均水平。APS能够根据终末幅度可靠地预测喉返神经麻痹。
