Yu Xing, Zhu Ruiying, Zhu Peifeng, Du Yu, Tanu Cheerly, Han Zhenyi, Jiang Neng, Pan Lei, Xie Chaoran, Zhao Qunzi, Wang Yong
Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine.
Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine.
Int J Surg. 2025 Jan 1;111(1):904-912. doi: 10.1097/JS9.0000000000001970.
Protecting recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), a crucial indicator for assessing the quality of thyroid surgery, poses a challenge in endoscopic thyroidectomy. The aim of this study was to investigate the effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy.
In this retrospective cohort study, patients underwent endoscopic thyroidectomy were included, and the characteristics and outcomes of real-time monitoring and intermittent monitoring groups were compared. Thereafter, the outcomes of four surgical types (unilateral lobectomy, total thyroidectomy, unilateral lobectomy + lymph node dissection (LND), and total thyroidectomy + LND) were compared in both groups.
A total of 1621 patients were enrolled. Compared to intermittent monitoring group, real-time monitoring group significantly shortened operation durations in the four surgical types (30.8±6.1 min vs. 35.7±5.7 min, 54.7±4.4 min vs. 59.1±5.2 min, 39.3±4.6 min vs. 42.0±4.7 min, 59.1±4.9 min vs. 66.0±5.8 min, respectively). As for surgical complications, compared to intermittent monitoring group, real-time monitoring group had lower rates of transient vocal cord paralysis among the four surgical types (0.0 vs. 3.3%, 0.0% vs. 4.0%, 0.8 vs. 3.2%, 2.8 vs. 6.7%, respectively), and lower rates of EBSLN injury (1.1 vs. 4.4%, 0.0 vs. 12.0%, 0.8 vs. 3.8%, 0.9 vs. 4.8%, respectively). Clinicopathologic characteristics and postoperative inflammatory reactions were similarly paralleled in both groups.
Implementation of real-time monitoring in endoscopic thyroidectomy effectively protects the RLN and EBSLN while shortening operation duration, demonstrating its feasibility and efficacy in enhancing nerve protection and surgical efficiency.
保护喉返神经（RLN）和喉上神经外支（EBSLN）是评估甲状腺手术质量的关键指标，在内镜甲状腺手术中具有挑战性。本研究旨在探讨神经实时监测和间歇性监测在内镜甲状腺手术中的有效性和可行性。
在这项回顾性队列研究中，纳入接受内镜甲状腺手术的患者，比较实时监测组和间歇性监测组的特征及结果。此后，比较两组四种手术类型（单侧甲状腺叶切除术、全甲状腺切除术、单侧甲状腺叶切除术+淋巴结清扫术（LND）和全甲状腺切除术+LND）的结果。
共纳入1621例患者。与间歇性监测组相比，实时监测组在四种手术类型中显著缩短了手术时间（分别为30.8±6.1分钟对35.7±5.7分钟、54.7±4.4分钟对59.1±5.2分钟、39.3±4.6分钟对42.0±4.7分钟、59.1±4.9分钟对66.0±5.8分钟）。至于手术并发症，与间歇性监测组相比，实时监测组在四种手术类型中短暂声带麻痹发生率较低（分别为0.0%对3.3%、0.0%对4.0%、0.8%对3.2%、2.8%对6.7%），EBSLN损伤发生率也较低（分别为1.1%对4.4%、0.0%对12.0%、0.8%对3.8%）。两组的临床病理特征和术后炎症反应相似。
在内镜甲状腺手术中实施实时监测可有效保护RLN和EBSLN，同时缩短手术时间，证明其在增强神经保护和手术效率方面的可行性和有效性。
