摘要
目的:探讨术中神经监测(IONM)在甲状腺癌再次手术中预防喉返神经(RLN)损伤的临床应用价值。方法:选择2012年1月—2014年12月行甲状腺癌再次手术137例患者,其中41例行术中单纯RLN肉眼识别(对照组),96例行术中RLN肉眼识别+IONM(研究组)。比较两组之间RLN识别及损伤率、平均手术时间、术后引流量、甲状旁腺损伤率的差异。结果:研究组RLN识别率100%(96/96),对照组为82.3%(34/41),差异有统计学意义(P<0.05);与对照组比较,研究组RLN损伤率(1.0% vs.9.8%)、术后引流量(38.1 mL vs.44.1 mL)均明显降低(均P<0.05);甲状旁腺损伤率两组间差异无统计学意义(8.3% vs.12.2%,P>0.05)。结论:IONM的应用能更好地提高甲状腺癌再次手术中RLN的识别率及降低其损伤率,减少术后并发症。
Objective： To investigate the clinical application value of intraoperative neuromonitoring（IONM） in the prevention of recurrent laryngeal nerve（RLN） injury during repeated operation for thyroid carcinoma. Methods： One hundred and thirty-seven patients scheduled to undergo a repeated operation for thyroid cancer from January 2012 to December 2014 were selected. Of the patients, RLN in 41 cases was identified by nakedeye inspection only during operation（control group）, and in 96 cases was identified by naked-eye inspection combined with IONM（study group）. The RLN recognition and injury rates, postoperative drainage and incidence of parathyroid damage between the two groups were compared.Results：The RLN recognition rate was 100%（96/96） in study group and 82.3%（34/41） in control group, and the difference had statistical significance（P〈0.05）. In study group versus control group, the incidence of RLN damage（1.0% vs. 9.8%） and postoperative drainage（38.1 mL vs. 44.1 mL） were significantly reduced（both P〈0.05）. The difference in incidence of parathyroid injury between the two groups had no statistical significance（8.3% vs. 12.2%, P〉0.05）. Conclusion： Application of IONM during repeated surgery for thyroid cancer can effectively improve RLN recognition and reduce the incidence of RLN injury, as well as reduce the incidence of complications.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2016年第5期648-652,共5页
China Journal of General Surgery
关键词
甲状腺肿瘤
再手术
喉返神经损伤
监测
手术中
Thyroid Neoplasms
Reoperation
Recurrent Laryngeal Nerve Injuries
Monitoring
Intraoperative
