甲状腺手术中的术中神经监测：喉返神经识别及手术时间分析
Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time.
作者信息
Maneeprasopchoke Prachya, Chongkolwatana Cheerasook, Pongsapich Warut, Iwata Ayaka J, Kamani Dipti, Randolph Gregory W
机构信息
Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand.
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston Massachusetts USA.
出版信息
Laryngoscope Investig Otolaryngol. 2021 Feb 26;6(2):354-361. doi: 10.1002/lio2.543. eCollection 2021 Apr.
OBJECTIVE
To evaluate the clinical value of intraoperative nerve monitoring (IONM) by comparing the procedure times for thyroidectomies performed with and without IONM.
METHODS
A prospective, randomized, controlled study was conducted on 32 patients (representing 41 nerves at risk) undergoing thyroidectomies carried out by two experienced head and neck surgeons (CC & WP). Sixteen thyroidectomies were performed without IONM (the "non-IONM group"), while 16 thyroidectomies were performed with IONM (the "IONM group"). The measured datapoints were setup time, time to visual identification of the recurrent laryngeal nerve (RLN), time to confirm the RLN electrophysiologically, dissection time, and total operative time.
RESULTS
With both surgeons, the IONM group had shorter visual times to RLN identification than the non-IONM group (CC: 3.7 minutes vs 5.3 minutes; WP: 3.4 minutes vs 9.7 minutes). Additionally, the electrophysiological identification time for the IONM group was shorter than the visual identification time for the non-IONM group. The setup times, dissection times, and total operative times of the 2 groups did not significantly differ ( > .05). No RLN injuries were observed.
CONCLUSIONS
IONM reduces the time needed for RLN identification in thyroidectomies. Functional RLN confirmation can reassure surgeons of the operative results. Moreover, use of IONM does not significantly impact setup and total operative times.
LEVEL OF EVIDENCE
目的
通过比较有或没有术中神经监测（IONM）的甲状腺切除术的手术时间，评估术中神经监测的临床价值。
方法
对32例患者（共41条有风险的神经）进行了一项前瞻性、随机对照研究，这些患者接受了由两位经验丰富的头颈外科医生（CC和WP）实施的甲状腺切除术。16例甲状腺切除术未使用IONM（“非IONM组”），而16例甲状腺切除术使用了IONM（“IONM组”）。测量的数据点包括设置时间、肉眼识别喉返神经（RLN）的时间、通过电生理确认RLN的时间、解剖时间和总手术时间。
结果
两位外科医生实施手术时，IONM组肉眼识别RLN的时间均短于非IONM组（CC：3.7分钟对5.3分钟；WP：3.4分钟对9.7分钟）。此外，IONM组的电生理识别时间短于非IONM组的肉眼识别时间。两组的设置时间、解剖时间和总手术时间无显著差异（P>0.05）。未观察到RLN损伤。
结论
IONM可减少甲状腺切除术中识别RLN所需的时间。通过电生理确认RLN功能可让外科医生对手术结果放心。此外，使用IONM对设置时间和总手术时间无显著影响。
证据级别
2级。
Zotero 插件