甲状腺手术中监测喉上神经外支时肌电图波形下的面积。
The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery.
作者信息
Zhao Yishen, Zhao Zihan, Wang Tie, Zhang Daqi, Dionigi Gianlorenzo, Sun Hui
机构信息
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China.
Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood 'Gaetano Barresi', University Hospital G. Martino, University of Messina, Messina, Italy.
出版信息
Gland Surg. 2021 Jan;10(1):143-153. doi: 10.21037/gs-20-570.
BACKGROUND
Injuries to the external branches of the superior laryngeal nerve (EBSLN) are difficult to identify during thyroidectomy. Monitoring the low amplitudes of the EBSLN during surgery has proven to be complicated. Therefore a new parameter, the area under the waveform (AUW), was designed to improve monitoring efficiency. The aim of this study was to determine the effectiveness of using AUW to monitor the EBSLN during thyroidectomy.
METHODS
A total of 927 patients and 927 recurrent laryngeal nerves (RLN) and EBSLNs who underwent monitored unilateral thyroidectomy were included. Standardized intraoperative neuromonitoring procedures were followed. RLN injuries were confirmed using stroboscopic laryngoscopy after surgery. EBSLN injuries were identified by means of observing changes in cricothyroid muscle (CTM) twitches when stimulated. Amplitude and AUW changes were assessed using statistical analysis. The correlations between AUW and amplitude were verified using the ratio of the two parameters to determine any decreases that were observed in the number of nerve injury cases. The receiver operating characteristic (ROC) curve was used to estimate the prediction of nerve injury.
RESULTS
The overall injury rates of the RLN and EBSLN were 3.56% and 2.05%, respectively. The AUW for the RLN and EBSLN presented linear correlations with amplitude. In the RLN injury cases, no significant difference was observed between the two parameters (P>0.05). In the cases with EBSLN injuries, the AUW decreased 64.5%±14.1%, on average, which was a greater decrease compared to that observed for amplitude 49.7%±22.2% (P<0.0001). The summary of the EBSLN injury prediction included, amplitude AUW, AUC: 0.918 0.994; P<0.0001, and Youden's index: 31.54% 49.58%.
CONCLUSIONS
The AUW demonstrated consistency with the change in amplitude, and the observed changes were significant. The use of the AUW allowed successful predictions for both RLN and EBSLN nerve injuries. Also, the sensitivity of AUW was greater than amplitude for predicting EBSLN injuries.
背景
甲状腺切除术中，喉上神经外支（EBSLN）损伤难以识别。手术中监测EBSLN的低振幅已被证明很复杂。因此，设计了一个新参数——波形下面积（AUW），以提高监测效率。本研究的目的是确定在甲状腺切除术中使用AUW监测EBSLN的有效性。
方法
纳入927例行单侧甲状腺切除术且接受神经监测的患者及927条喉返神经（RLN）和EBSLN。遵循标准化的术中神经监测程序。术后使用频闪喉镜确认RLN损伤。通过观察刺激时环甲肌（CTM）抽搐的变化来识别EBSLN损伤。使用统计分析评估振幅和AUW的变化。使用两个参数的比值验证AUW与振幅之间的相关性，以确定神经损伤病例数量的任何减少情况。采用受试者工作特征（ROC）曲线来估计神经损伤的预测情况。
结果
RLN和EBSLN的总体损伤率分别为3.56%和2.05%。RLN和EBSLN的AUW与振幅呈线性相关。在RLN损伤病例中，两个参数之间未观察到显著差异（P>0.05）。在EBSLN损伤病例中，AUW平均下降64.5%±14.1%，与振幅下降49.7%±22.2%相比，下降幅度更大（P<0.0001）。EBSLN损伤预测总结包括，振幅、AUW，曲线下面积（AUC）：0.918、0.994；P<0.0001，以及约登指数：31.54%、49.58%。
结论
AUW与振幅变化一致，且观察到的变化显著。使用AUW能够成功预测RLN和EBSLN神经损伤。此外，在预测EBSLN损伤方面，AUW的敏感性高于振幅。
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