喉返神经损伤并发症：内镜经双侧乳晕入路和开放甲状腺切除术技术的经验教训。
Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique.
机构信息
Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China.
Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
出版信息
World J Surg. 2019 Nov;43(11):2829-2841. doi: 10.1007/s00268-019-05092-x.
BACKGROUND AND AIM
Elucidating the mechanism of recurrent laryngeal nerve (RLN) injuries through intraoperative electromyographic (EMG) and laryngeal examination approaches may deepen our knowledge regarding its prevention strategies. To date, no studies have been reported on the mechanism of RLN injury caused by endoscopic thyroidectomy via bilateral areola approach (ETBAA).
METHODS
Both intraoperative EMG profiles and postoperative laryngeal examination were used to investigate the mechanisms of RLN injury and compare the safety aspects between ETBAA and open thyroidectomy approach (OTA).
RESULTS
This study examined 1420 nerves at risk. The mean follow-up period was 17 ± 4 (range 6-48) months. The incidence of vocal cord paralysis was 4.1% (59/1420). The number of cases with decreased EMG signals and vocal cord palsy was higher in ETBAA group than in OTA group (P < 0.05). The left RLNs in ETBAA group were at higher risk compared to the right nerves.
CONCLUSIONS
The results of the current study indicate that ETBAA exhibits higher risk of RLN injury. The topic includes a video.
背景与目的
通过术中肌电图（EMG）和喉镜检查方法阐明喉返神经（RLN）损伤的机制，可能会加深我们对其预防策略的认识。迄今为止，尚无关于经乳晕入路内镜甲状腺切除术（ETBAA）引起 RLN 损伤机制的研究报告。
方法
本研究采用术中 EMG 谱和术后喉镜检查来探讨 RLN 损伤的机制，并比较 ETBAA 与开放甲状腺切除术（OTA）的安全性方面。
结果
本研究共检查了 1420 条有风险的神经。平均随访时间为 17±4（6-48）个月。声带麻痹的发生率为 4.1%（59/1420）。与 OTA 组相比，ETBAA 组的 EMG 信号减弱和声带麻痹的病例数更高（P<0.05）。ETBAA 组的左侧 RLN 比右侧 RLN 更容易受损。
结论
本研究结果表明，ETBAA 显示出更高的 RLN 损伤风险。本研究包含一段视频。
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