Smaxwil Constantin, Aleker Miriam, Altmeier Julia, Naddaf Ali, Busch Mirjam, Wagner Joachim, Harsch Simone, Ploner Oswald, Zielke Andreas
Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany.
Outcomes Research Unit, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany.
J Clin Med. 2021 Feb 12;10(4):740. doi: 10.3390/jcm10040740.
Bilateral vocal cord dysfunction (bVCD) is a rare but feared complication of thyroid surgery. This long term retrospective study determined the effect of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgeries with regard to the rate of bVCD and evaluated the frequency as well as the outcome of staged operations.
Retrospective analysis of prospectively documented data (2000-2019) of a tertiary referral centers' database. IONM started in 2000 and, since 2010, discontinuation of surgery was encouraged in planned bilateral surgeries to prevent bVCD, if non-transient loss of signal (ntLOS) occurred on the first side. Datasets of the most recent 40-month-period were assessed in detail to determine the clinical outcome of unilateral ntLOS in planned bilateral thyroid procedures.
Of 22,573 patients, 65 had bVCD (0.288%). The rate of bVCD decreased from 0.44 prior to 2010 to 0.09% after 2010 ( < 0.001, Chi2). Case reviews of the most recent 40 months period identified ntLOS in 113/3115 patients (3.6%, 2.2% NAR), of which 40 ntLOS were recorded during a planned bilateral procedure ( = 952, 2.1% NAR). Of 21 ntLOS occurring on the first side of the bilateral procedure, 15 procedures were stopped, subtotal contralateral resections were performed, and thyroidectomy was continued in 3 patients respectively, with the use of continuous vagal IONM. Eighteen cases of VCD were documented postop, and all but one patient had a full recovery. Seven patients had staged resections after 1 to 18 months (median 4) after the first procedure.
IONM facilitates reduced postoperative bVCD rates. IONM is, therefore, recommendable in planned bilateral procedures. The rate of non-complete bilateral surgery after intraoperative non-transient LOS was 2%.
双侧声带功能障碍（bVCD）是甲状腺手术罕见但令人担忧的并发症。这项长期回顾性研究确定了甲状腺手术中喉返神经（RLN）术中神经监测（IONM）对bVCD发生率的影响，并评估了分期手术的频率和结果。
对一家三级转诊中心数据库前瞻性记录的数据（2000 - 2019年）进行回顾性分析。IONM始于2000年，自2010年起，如果在计划的双侧手术中一侧出现非短暂性信号丢失（ntLOS），则鼓励停止手术以预防bVCD。对最近40个月期间的数据集进行详细评估，以确定计划双侧甲状腺手术中单侧ntLOS的临床结果。
在22573例患者中，65例发生bVCD（0.288%）。bVCD发生率从2010年前的0.44%降至2010年后的0.09%（<0.001，卡方检验）。对最近40个月期间的病例回顾发现，113/3115例患者（3.6%，非预期再手术率2.2%）出现ntLOS，其中40例ntLOS记录于计划的双侧手术期间（n = 952，非预期再手术率2.1%）。在双侧手术的第一侧出现的21例ntLOS中，15例手术停止，对侧进行次全切除术，3例患者分别在持续迷走神经IONM下继续进行甲状腺切除术。术后记录到18例声带功能障碍（VCD），除1例患者外，所有患者均完全恢复。7例患者在首次手术后1至18个月（中位时间4个月）进行了分期切除术。
IONM有助于降低术后bVCD发生率。因此，在计划的双侧手术中推荐使用IONM。术中非短暂性LOS后非完全双侧手术的发生率为2%。
