甲状腺切除术后术中神经监测对声带麻痹发生率的影响：欧洲多中心注册研究。
Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study.
机构信息
Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, Mainz, Germany.
Institute for Medical Biometry, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany.
出版信息
BJS Open. 2020 Oct;4(5):821-829. doi: 10.1002/bjs5.50310. Epub 2020 Jun 16.
BACKGROUND
Intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) predicts the risk of vocal cord palsy (VCP). IONM can be used to adapt the surgical strategy in order to prevent bilateral VCP and associated morbidity. Controversial results have been reported in the literature for the effect of IONM on rates of VCP, and large multicentre studies are required for elucidation.
METHODS
Patients undergoing first-time thyroidectomy for benign thyroid disease between May 2015 and January 2019, documented prospectively in the European registry EUROCRINE®, were included in a cohort study. The influence of IONM and other factors on the development of postoperative VCP was analysed using multivariable regression analysis.
RESULTS
Of 4598 operations from 82 hospitals, 3542 (77·0 per cent) were performed in female patients. IONM was used in 4182 (91·0 per cent) of 4598 operations, independent of hospital volume. Postoperative VCP was diagnosed in 50 (1·1 per cent) of the 4598 patients. The use of IONM was associated with a lower risk of postoperative VCP in multivariable analysis (odds ratio (OR) 0·34, 95 per cent c.i. 0·16 to 0·73). Damage to the RLN noted during surgery (OR 24·77, 12·91 to 48·07) and thyroiditis (OR 2·03, 1·10 to 3·76) were associated with an increased risk of VCP. Higher hospital volume correlated with a lower rate of VCP (OR 0·05, 0·01 to 0·13).
CONCLUSION
Use of IONM was associated with a low rate of postoperative VCP.
背景
术中喉返神经（RLN）监测（IONM）可预测声带麻痹（VCP）的风险。IONM 可用于调整手术策略，以防止双侧 VCP 及其相关发病率。文献中报道的 IONM 对 VCP 发生率的影响存在争议，需要进行大型多中心研究来阐明。
方法
本队列研究纳入了 2015 年 5 月至 2019 年 1 月期间在欧洲登记处 EUROCRINE®中记录的首次因良性甲状腺疾病行甲状腺切除术的患者。使用多变量回归分析评估 IONM 及其他因素对术后 VCP 发展的影响。
结果
在 82 家医院的 4598 例手术中，3542 例（77.0%）为女性患者。4598 例手术中，4182 例（91.0%）独立于医院容量使用了 IONM。4598 例患者中，术后 VCP 诊断为 50 例（1.1%）。多变量分析显示，使用 IONM 与术后 VCP 风险降低相关（比值比（OR）0.34，95%置信区间（CI）0.16 至 0.73）。术中 RLN 损伤（OR 24.77，12.91 至 48.07）和甲状腺炎（OR 2.03，1.10 至 3.76）与 VCP 风险增加相关。较高的医院容量与较低的 VCP 发生率相关（OR 0.05，0.01 至 0.13）。
结论
使用 IONM 与术后 VCP 发生率低相关。
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