Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
J Int Med Res. 2021 Mar;49(3):3000605211000987. doi: 10.1177/03000605211000987.
To investigate the factors associated with adherence of an enlarged parathyroid gland to the recurrent laryngeal nerve (RLN) and the effectiveness of intraoperative neural monitoring (IONM).
This single-center retrospective study involved samples from 197 consecutive patients (394 RLNs; 733 parathyroid glands) who underwent parathyroidectomy and transcervical thymectomy between September 2010 and December 2014. The presence of parathyroid gland adhesion to the RLN and the clinical characteristics of patients with and without nerve adhesion were recorded. All patients underwent intraoperative monitoring of the electromyographic responses of the vocal cords using the endotracheal NIM-Response 3.0 system. The patients' postoperative clinical outcomes were recorded.
Parathyroid gland adhesion to the RLN was significantly associated with maximum gland diameter (>15 mm), weight (>500 mg), and the presence of nodular hyperplasia. IONM demonstrated a sensitivity of 97.8%, specificity of 43.5%, and accuracy of 94.7% for detecting nerve damage. Parathyroid gland adhesion to 17 RLNs occurred in 3 cases (17.6%) of vocal cord paralysis, whereas the 377 glands without nerve adhesion resulted in vocal cord paralysis in 20 cases (5.3%).
Our findings demonstrated the effectiveness of IONM using endotracheal electromyography in patients who underwent parathyroidectomy for secondary hyperparathyroidism.
探讨与扩大甲状旁腺与喉返神经（RLN）粘连相关的因素，以及术中神经监测（IONM）的效果。
这是一项单中心回顾性研究，样本来自 197 例连续患者（394 条 RLN；733 个甲状旁腺），他们在 2010 年 9 月至 2014 年 12 月期间接受甲状旁腺切除术和经颈胸腺切除术。记录甲状旁腺与 RLN 粘连的存在情况，以及有神经粘连和无神经粘连患者的临床特征。所有患者均使用气管内 NIM-Response 3.0 系统进行声带肌电图的术中监测。记录患者术后的临床转归。
甲状旁腺与 RLN 的粘连与最大腺体直径（>15mm）、重量（>500mg）和结节性增生的存在显著相关。IONM 对检测神经损伤的敏感性为 97.8%，特异性为 43.5%，准确性为 94.7%。17 个 RLN 上的甲状旁腺粘连在 3 例（17.6%）声带麻痹中发生，而 377 个无神经粘连的腺体在 20 例（5.3%）中导致声带麻痹。
我们的研究结果表明，在接受甲状旁腺切除术治疗继发性甲状旁腺功能亢进的患者中，使用气管内肌电图的 IONM 是有效的。
