Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment Changchun, Changchun, China.
Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy.
Front Endocrinol (Lausanne). 2023 Nov 28;14:1299943. doi: 10.3389/fendo.2023.1299943. eCollection 2023.
Although intraoperative neural monitoring (IONM) is well established in thyroid surgery, it is less commonly analyzed in parathyroid operations. This study presents the results of IONM for primary and secondary hyperparathyroidism surgery.
We retrospectively assessed 270 patients with primary hyperparathyroidism (PHPT), 53 patients with secondary hyperparathyroidism (SHPT), and 300 patients with thyroid cancer from June 2010 to June 2022 in one hospital in China. The follow-up was 12 months. Demographic, electromyography data from IONM, laboratory, and clinical information were collected. Laryngoscopy was collected from 109 patients with PHPT in whom IONM was not used. All groups were assessed by Pearson's chi-square test and Fisher's exact probability method to verify the relationship between parathyroid size and location, duration of surgery, preoperative concordant localization, laryngeal pain, IONM outcomes, cure rate, and RLN injury. Visual analog scale (VAS) assessed laryngeal pain. RLN outcomes were measured according to nerves at risk (NAR).
The study comprehended 918 NAR, that is 272, 105, 109, and 432 NAR for PHPT, SHPT with IONM, PHPT without IONM, and thyroid surgery control group, respectively. IONM successfully prevented RLN injury (P<0.001, P=0.012): Fifteen (5.51%) RLNs experienced altered nerve EMG profiles during surgery, and five (1.84%) experienced transient RLN injury in PHPT patients. Five (4.76%) RLNs were found to have altered EMG profiles during surgery, and one (0.95%) RLN had a transient RLN injury in SHPT patients. There was no permanent nerve injury (0.00%) in this series. There was no association between location, gland size, preoperative concordant localization, cure rate, duration of surgery, and IONM (P >0.05). Duration of surgery was associated with postoperative pharyngeal discomfort (P=0.026, P=0.024). Transient RLN injury was significantly lower in patients with PHPT who underwent IONM than in those who did not. Intraoperative neuromonitoring played an effective role in protecting the recurrent laryngeal nerve (P=0.035). Compared with parathyroidectomy, thyroidectomy had a higher rate of RLN injury (5.32%, P<0.001).
IONM for SHPT and PHPT offers rapid anatomical gland identification and RLN functional results for effective RLN protection and reduced RLN damage rates.
尽管术中神经监测（IONM）在甲状腺手术中已得到广泛应用，但在甲状旁腺手术中应用较少。本研究介绍了 IONM 在原发性和继发性甲状旁腺功能亢进症手术中的应用结果。
我们回顾性评估了 2010 年 6 月至 2022 年 6 月期间在中国一家医院接受手术的 270 例原发性甲状旁腺功能亢进症（PHPT）患者、53 例继发性甲状旁腺功能亢进症（SHPT）患者和 300 例甲状腺癌患者。随访时间为 12 个月。收集了人口统计学、IONM 中的肌电图数据、实验室和临床信息。对 109 例未使用 IONM 的 PHPT 患者进行了喉镜检查。所有组均采用 Pearson's chi-square 检验和 Fisher's 确切概率法进行评估，以验证甲状旁腺大小和位置、手术持续时间、术前定位一致性、咽喉疼痛、IONM 结果、治愈率和 RLN 损伤之间的关系。采用视觉模拟量表（VAS）评估咽喉疼痛。根据风险神经（NAR）测量 RLN 结果。
本研究包括 918 个 NAR，分别为 272、105、109 和 432 个 NAR，用于 PHPT、有 IONM 的 SHPT、无 IONM 的 PHPT 和甲状腺手术对照组。IONM 成功预防了 RLN 损伤（P<0.001，P=0.012）：在 PHPT 患者中，有 15 例（5.51%）RLN 在手术中经历了改变的神经肌电图特征，有 5 例（1.84%）RLN 发生了短暂性 RLN 损伤。在 SHPT 患者中，有 5 例（4.76%）RLN 在手术中经历了改变的肌电图特征，有 1 例（0.95%）RLN 发生了短暂性 RLN 损伤。在本系列中没有发生永久性神经损伤（0.00%）。位置、腺体大小、术前定位一致性、治愈率、手术持续时间和 IONM 之间没有相关性（P>0.05）。手术持续时间与术后咽部不适相关（P=0.026，P=0.024）。与未接受 IONM 的 PHPT 患者相比，接受 IONM 的 PHPT 患者的暂时性 RLN 损伤显著降低。术中神经监测在保护喉返神经方面发挥了有效作用（P=0.035）。与甲状旁腺切除术相比，甲状腺切除术 RLN 损伤发生率更高（5.32%，P<0.001）。
IONM 可用于 SHPT 和 PHPT，快速识别解剖腺体并提供 RLN 功能结果，有助于有效保护 RLN，降低 RLN 损伤率。
