术中神经监测技术在甲状腺手术中的临床应用

Clinical application of intraoperative neuromonitoring in thyroidectomy

摘要:

目的 探讨术中神经监测技术（IONM）在甲状腺手术中的临床价值。方法 回顾性分析2016年 1月—2018年9月山西医科大学第二医院行甲状腺手术治疗的患者370例，按术中是否应用IONM分为观察组 （n?=179）和对照组（n?=191）。比较两组良性肿瘤行次全切除术、全切除术后喉返神经（RLN）损伤率；比较 两组恶性肿瘤行甲状腺全切除及颈淋巴结清扫术后RLN损伤率；比较两组手术时间及手术费用；比较观察组术中RLN肌电信号振幅变化与术后RLN损伤症状的关系；比较两组喉上神经外支（EBLSN）的识别率；记录 观察组监测EBSLN获得的肌电信号、环甲肌震颤结果。结果 两组良性肿瘤行次全切除术后RLN暂时性损伤率和永久性损伤率比较，差异无统计学意义（P?>0.05）；两组良性肿瘤行全切除术后RLN暂时性损伤率比较，差异有统计学意义（P?<0.05），永久性损伤率比较，差异无统计学意义（P?>0.05）；两组恶性肿瘤行甲状腺全切除及颈淋巴结清扫术后RLN暂时性损伤率比较，差异有统计学意义（P?<0.05）；永久性损伤率比较，差异 无统计学意义（P?>0.05）。两组手术时间和手术费用比较，差异有统计学意义（P?<0.05）。观察组4例出现术后RLN损伤症状，其对应肌电信号振幅变化幅度在0%～50%。两组EBSLN识别率比较，差异有统计学意义（P?< 0.05）。观察组可识别EBSLN中28.86%获得肌电图，71.14%引出环甲肌震颤。结论 甲状腺手术中应用IONM有助于降低RLN的损伤率；利用术中RLN肌电信号振幅变化可以预测神经功能；IONM有助于提高EBSLN的识别率，同时结合环甲肌震颤识别EBSLN更加精准。

Abstract:

Objective To evaluate the clinical value of intraoperative neuromonitoring in thyroidectomy. Methods A total of 370 patients who underwent thyroidectomy in our hospital from January 2016 to September 2018 were retrospectively analyzed and divided into the observation group (179 cases) and the control group (191 cases) according to whether neuromonitoring was used during the operation. The injury rate of RLN after subtotal resection and total resection was compared between the observation group and the control group. The rate of RLN injury after total thyroidectomy and cervical lymph node dissection was compared between the observation group and the control group. The operation time and cost were compared between the observation group and the control group. The relationship between the amplitude of intraoperative RLN EMG signal and postoperative RLN injury symptoms was compared in the observation group. The recognition rate of EBLSN was compared between the observation group and the control group. EBSLN EMG signal and cricothyroid muscle tremor were recorded in the observation group. Results There was no statistically significant difference in the rate of temporary injury of RLN (P?>?0.05) between the observation group and the control group after subtotal resection of benign tumors. There was no statistically significant difference in the rate of permanent injury of RLN (P?>?0.05) between the observation group and the control group after subtotal resection of benign tumors. There was no statistically significant difference in the rate of temporary injury of RLN (P?>?0.05) after total resection of benign tumors in the observation group and the control group; there was no statistically significant difference in the rate of permanent injury of RLN (0/0, P?>?0.05) after total resection of benign tumors in the observation group and the control group. There was statistically significant difference in the rate of permanent injury of RLN (P??0.05). The differences of operation time and operation cost were statistically significant (P?