Del Rio P, Cozzani F, Puteo N, Loderer T, Rossini Maurizio, Bonati E
G Chir. 2019 May-Jun;40(3):174-181.
The aim of this study is to identify statistically significant differences in the onset of postoperative complications in patients undergoing thyroid surgery for benign pathology, following the systematic introduction of intraoperative neuromonitoring (IONM) of the laryngeal nerves.
In this study we have retrospectively analysed data of 604 consecutive patients underwent to thyroidectomy in the Unit of General Surgery - University Hospital of Parma between January 2011 and December 2017. All patients were divided in two groups: the first group of patients was operated without the use of IONM (Group A) the second group was operated after the introduction of the systematic use of IONM (Group B). We have compared the incidence of adverse events in these two groups, analysing the impact of IONM on the onset of the most frequent complications after thyroid surgery. We have considered the impact of other variables in both groups, such as thyroiditis, hyperfunction and gland sinking in mediastinum.
No statistically significant differences in the incidence between Group A (patients operated without the use of IONM) and Group B (patients operated with the use of IONM) were detected, though a decreasing trend after the introduction of IONM was observed. No statistically significant differences were reported even analysing the influence of other patient's variables such as thyroiditis, hyperfunction and glandular sinking in mediastinum.
Even if the number of patients considered is not sufficient to value statistically significant differences, the decreasing trend of the incidence of postoperative complications after introduction of IONM encourage us. The surgeon expertise is still the most relevant variable influencing the decreasing of postoperative complications, underlining the importance of the centralization of this kind of surgery in the high volume centres.
本研究旨在确定在对良性病变进行甲状腺手术的患者中，系统引入喉返神经术中神经监测（IONM）后，术后并发症发生时间上的统计学显著差异。
在本研究中，我们回顾性分析了2011年1月至2017年12月期间在帕尔马大学医院普通外科接受甲状腺切除术的604例连续患者的数据。所有患者分为两组：第一组患者在手术时未使用IONM（A组），第二组患者在系统引入IONM后进行手术（B组）。我们比较了这两组不良事件的发生率，分析了IONM对甲状腺手术后最常见并发症发生的影响。我们还考虑了两组中其他变量的影响，如甲状腺炎、功能亢进和腺体坠入纵隔。
未检测到A组（未使用IONM进行手术的患者）和B组（使用IONM进行手术的患者）之间发生率的统计学显著差异，尽管在引入IONM后观察到有下降趋势。在分析其他患者变量如甲状腺炎、功能亢进和腺体坠入纵隔的影响时，也未报告有统计学显著差异。
即使所考虑的患者数量不足以评估统计学显著差异，但引入IONM后术后并发症发生率的下降趋势仍给我们带来鼓舞。外科医生的专业技能仍然是影响术后并发症减少的最相关变量，这凸显了将此类手术集中在高容量中心的重要性。
