Onoda Naoyoshi, Noda Satoru, Tauchi Yukie, Asano Yuka, Kusunoki Yukina, Ishihara Sae, Morisaki Tamami, Kashiwagi Shinichiro, Takashima Tsutomu, Ohira Masaichi
Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan.
Laryngoscope Investig Otolaryngol. 2019 Jul 18;4(4):455-459. doi: 10.1002/lio2.290. eCollection 2019 Aug.
We evaluated the utility of continuous intraoperative neuromonitoring (CIONM) during surgery for thyroid cancer (TC) in an educational university hospital.
Prospective observational study.
During the period April 2016 to March 2017, 43 patients who underwent standardized surgery with CIONM were prospectively included: 5 men and 38 women, 24-87 years old (median 52 years); 23 lobectomies and 20 total thyroidectomies with node dissection were conducted. Thirty-six operations were performed by a supervising surgeon, and seven were performed by trainees.
Temporal vocal cord paresis (VCP) was identified in 9 of 63 nerves at risk (14.3%) by postoperative laryngoscopy. VCP was not related to clinical factors including the surgeon's experience or the severe nerve stress demonstrated by CIONM. A significant relation only between VCP and loss of signal (LOS) was demonstrated ( = .002). The recovery of VCP was rapid (<1 month) in patients with global injury even when LOS was demonstrated, but was prolonged in patients demonstrating obvious segmental nerve injury and LOS.
The present standard protocol of CIONM was useful to some extent to protect prolonged VCP, but not enough to detect every nerve stress causing VCP during TC surgery. On the other hand, CIONM is a promising method that could contribute surgical education at training hospitals enabling the instant confirmation of the procedure safely.
3b.
我们在一所教学型大学医院评估了甲状腺癌（TC）手术中连续术中神经监测（CIONM）的效用。
前瞻性观察研究。
在2016年4月至2017年3月期间，前瞻性纳入43例行标准化CIONM手术的患者：5名男性和38名女性，年龄24 - 87岁（中位数52岁）；实施了23例叶切除术和20例全甲状腺切除术并进行了淋巴结清扫。36例手术由指导医师完成，7例由实习医师完成。
术后喉镜检查发现63条有风险的神经中有9条（14.3%）出现暂时性声带麻痹（VCP）。VCP与包括外科医生经验或CIONM显示的严重神经应激等临床因素无关。仅显示VCP与信号丢失（LOS）之间存在显著关联（P = .002）。即使出现LOS，但整体损伤患者的VCP恢复迅速（<1个月），而出现明显节段性神经损伤和LOS的患者VCP恢复时间延长。
目前CIONM的标准方案在一定程度上有助于预防持续性VCP，但不足以检测出TC手术中导致VCP的每一种神经应激。另一方面，CIONM是一种有前景的方法，可为培训医院的外科教育做出贡献，使手术过程能够安全地即时确认。
3b。
