Department of Otolaryngology, Head and Neck Surgery.
Department of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China.
Int J Surg. 2023 Jul 1;109(7):2070-2081. doi: 10.1097/JS9.0000000000000393.
Thyroid disease is a common endocrine disorder, and thyroid surgeries and postoperative complications have increased recently. This study aimed to explore the effectiveness of intraoperative nerve monitoring (IONM) in endoscopic thyroid surgery using subgroup analysis and determine confounding factors.
Two researchers individually searched for relevant studies published till November 2022 in the PubMed, Embase, Web of Science and Cochrane Library databases. Eventually, eight studies met the inclusion criteria. Heterogeneity was assessed using the Cochran's Q test, and a funnel plot was implemented to evaluate publication bias. The odds ratio or risk difference were calculated using fixed-effects models. The weighted mean difference of continuous variables was calculated. Subgroup analysis was performed according to the disease type.
Eight eligible papers included 915 patients and 1242 exposed nerves. The frequencies of transient, permanent and total recurrent laryngeal nerve (RLN) palsy were 2.64, 0.19 and 2.83%, respectively, in the IONM group and 6.15, 0.75 and 6.90%, respectively, in the conventional exposure group. In addition, analysis of the secondary outcome indicators for the average total length of surgery, localisation time of the RLN, recognition rate of the superior laryngeal nerve and length of incision revealed that IONM reduced the localisation time of the RLN and increased the identification rate of the superior laryngeal nerve. Subgroup analysis showed that IONM significantly reduced the incidence of RLN palsy in patients with malignancies.
The use of IONM significantly reduced the incidence of transient RLN palsy during endoscopic thyroid surgery, but it did not significantly reduce the incidence of permanent RLN palsy. However, the reduction in the total RLN palsy was statistically significant. In addition, IONM can effectively reduce the location time of the RLN and increase the recognition rate of the superior laryngeal nerve. Therefore, the application of IONM for malignant tumours is recommended.
甲状腺疾病是一种常见的内分泌疾病，甲状腺手术及其术后并发症近年来有所增加。本研究旨在通过亚组分析探讨术中神经监测（IONM）在经内镜甲状腺手术中的效果，并确定混杂因素。
两名研究人员分别在 PubMed、Embase、Web of Science 和 Cochrane Library 数据库中搜索截至 2022 年 11 月发表的相关研究。最终有 8 项研究符合纳入标准。采用 Cochran's Q 检验评估异质性，并用漏斗图评估发表偏倚。采用固定效应模型计算比值比或风险差，采用加权均数差计算连续变量。根据疾病类型进行亚组分析。
8 篇合格文献纳入 915 例患者和 1242 条暴露神经。IONM 组暂时性、永久性和总喉返神经（RLN）麻痹的发生率分别为 2.64%、0.19%和 2.83%，常规暴露组分别为 6.15%、0.75%和 6.90%。此外，对手术总时长、RLN 定位时间、喉上神经识别率和切口长度等次要结局指标的分析表明，IONM 缩短了 RLN 的定位时间，提高了喉上神经的识别率。亚组分析显示，IONM 显著降低了恶性肿瘤患者 RLN 麻痹的发生率。
在经内镜甲状腺手术中使用 IONM 可显著降低暂时性 RLN 麻痹的发生率，但不能显著降低永久性 RLN 麻痹的发生率。然而，总 RLN 麻痹的发生率降低具有统计学意义。此外，IONM 能有效缩短 RLN 的定位时间，提高喉上神经的识别率。因此，建议对恶性肿瘤应用 IONM。
