General Surgery Unit, Parma University Hospital.
a:1:{s:5:"en_US";s:25:"Parma University Hospital";}.
Acta Biomed. 2022 May 11;93(2):e2022040. doi: 10.23750/abm.v93i2.11178.
The aim of this study was firstly to report the experience of intermittent intraoperative neuromonitoring (I-IONM) and evaluate the impact of loss of signal (LOS) in staged thyroidectomy management.
We retrospectively reviewed patients who underwent total thyroidectomy, performed by a single surgeon in two years. All patients have been subjected to I-IONM. In case of intraoperative loss of signal (LOS), planned total thyroidectomy was always aborted. Six-month follow-up was performed. Postoperative dysphonia was evaluated with VHI-10 score in 3 time settings T1, during hospital stay, T2 after 30 days, T3 after 6 months. Dysphonia has been compared to IONM results to evaluate sensitivity and specificity.
377 patients were included. Incidence of dysphonia was calculated based on the number of nerves at risk (NAR). We evaluated a total of 724 NAR. LOS encountered were 43 cases (5.9% of total NAR), of these 14 were LOS 1 while 29 were LOS 2. 27 patients (3.7% of NAR) presented early post-operative dysphonia with VHI-10 score > 13 (T1), among these 16 had presented LOS at IONM (true positives) while11 had no LOS (false negatives). In T2 and T3 we reported a decrease in true positive cases increasing false positives. Sensitivity at T3 reached 85.7% while specificity and odds ratio were respectively 94.8% and 110.
Given the high sensitivity and specificity, IONM should be considered a useful tool for thyroid surgery and its use should be suggested for patients undergoing planned total thyroidectomy. Its right application may cancel the risk of bilateral paralysis.
本研究旨在报告间歇性术中神经监测（I-IONM）的经验，并评估信号丢失（LOS）在分期甲状腺切除术管理中的影响。
我们回顾性分析了在两年内由一位外科医生进行全甲状腺切除术的患者。所有患者均接受 I-IONM。如果术中发生信号丢失（LOS），则计划的全甲状腺切除术将立即中止。进行 6 个月的随访。术后嗓音障碍采用 VHI-10 评分在 3 个时间点（T1：住院期间，T2：术后 30 天，T3：术后 6 个月）进行评估。将嗓音障碍与 IONM 结果进行比较，以评估敏感性和特异性。
共纳入 377 例患者。嗓音障碍的发生率根据风险神经（NAR）的数量计算。我们共评估了 724 个 NAR。共发生 LOS 43 例（总 NAR 的 5.9%），其中 LOS 1 为 14 例，LOS 2 为 29 例。27 例患者（NAR 的 3.7%）在术后早期出现 VHI-10 评分>13（T1）的嗓音障碍，其中 16 例在 IONM 时出现 LOS（真阳性），而 11 例未出现 LOS（假阴性）。在 T2 和 T3，我们报告真阳性病例减少，假阳性病例增加。T3 时的敏感性达到 85.7%，特异性和优势比分别为 94.8%和 110。
鉴于其高敏感性和特异性，IONM 应被视为甲状腺手术的有用工具，应建议计划进行全甲状腺切除术的患者使用。正确应用可能会消除双侧麻痹的风险。
