Yu Xing, Li Yujun, Liu Chang, Jiang Yuancong, Liu Zhaodi, He Qionghua, Wang Yong, Wang Ping
Department of Thyroid Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
College of Medicine, Zhejiang University, Hangzhou, China.
Front Oncol. 2022 Feb 23;12:779621. doi: 10.3389/fonc.2022.779621. eCollection 2022.
Energy-based devices (EBDs) increase the risks of thermal nerve injuries. This study aimed to introduce a surgical strategy of intraoperative neural tunnel protecting (INTP) for evaluating the effect in reducing the incidence of recurrent laryngeal nerve (RLN) damage in open, trans breast, and transoral endoscopic thyroidectomy.
INTP strategy was introduced: a tunnel was established and protected by endoscopic gauze along the direction of the nerve. A total of 165, 94, and 200 patients with papillary thyroid carcinoma (PTC) were to use INTP in respectively open, trans breast, and transoral endoscopic thyroidectomy as the INTP group. Additionally, 150, 95, and 225 patients who received the same methods without INTP were enrolled in the control group. Ipsilateral thyroidectomy or total thyroidectomy, and central compartment dissection were performed on the enrolled patients.
Clinicopathologic characteristics, surgical outcomes, and surgical complications were similar between the INTP group and the control group in open, trans breast, and transoral endoscopic thyroidectomy. The incidences of electromyography (EMG) changes in the INTP group were lower as compared to the control group in trans breast endoscopic thyroidectomy ( < 0.05). The incidence of postoperative hoarse in the INTP group was lower as compared to the control group in open and transoral endoscopic thyroidectomy ( < 0.05). Postoperative calcium levels ( < 0.01) were significantly higher, and the white blood cells ( < 0.05) and C-reactive protein levels ( < 0.01) were significantly decreased in the INTP group compared with the control group in transoral endoscopic thyroidectomy.
This was the first instance of the INTP strategy being introduced and was found to be an effective method for protecting the RLN in open, trans breast, and transoral endoscopic thyroidectomy. Additionally, INTP helped protect other important tissues such as the parathyroid glands in transoral endoscopic thyroidectomy as well as in reducing postoperative inflammatory responses.
基于能量的设备（EBDs）会增加热神经损伤的风险。本研究旨在介绍一种术中神经通道保护（INTP）的手术策略，以评估其在开放手术、经胸手术和经口内镜甲状腺切除术中降低喉返神经（RLN）损伤发生率的效果。
引入INTP策略：沿神经方向用内镜纱布建立并保护一个通道。分别有165例、94例和200例乳头状甲状腺癌（PTC）患者在开放手术、经胸手术和经口内镜甲状腺切除术中采用INTP作为INTP组。此外，150例、95例和225例接受相同手术方法但未采用INTP的患者作为对照组。对纳入的患者进行同侧甲状腺切除术或全甲状腺切除术以及中央区淋巴结清扫。
在开放手术、经胸手术和经口内镜甲状腺切除术中，INTP组和对照组的临床病理特征、手术结果和手术并发症相似。在经胸内镜甲状腺切除术中，INTP组肌电图（EMG）变化的发生率低于对照组（<0.05）。在开放手术和经口内镜甲状腺切除术中，INTP组术后声音嘶哑的发生率低于对照组（<0.05）。在经口内镜甲状腺切除术中，INTP组术后血钙水平（<0.01）显著高于对照组，白细胞（<0.05）和C反应蛋白水平（<0.01）显著低于对照组。
这是首次引入INTP策略，发现其是开放手术、经胸手术和经口内镜甲状腺切除术中保护喉返神经的有效方法。此外，INTP有助于在经口内镜甲状腺切除术中保护甲状旁腺等其他重要组织，并减少术后炎症反应。
