术中喉返神经监测在甲状腺癌再次手术中的应用价值  

Application value of intraoperative neuromonitoring of recurrent laryngeal nerve during reoperation for thyroid carcinoma

作　　者：刘勇军[1] 石朋飞[1] 胡波[1] 张晓毅[1] 江学庆[1] 

机构地区：[1]湖北省武汉市中心医院甲状腺乳腺外科,湖北武汉430014

出　　处：《中国普通外科杂志》2016年第5期648-652,共5页China Journal of General Surgery

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.

关 键 词：甲状腺肿瘤 再手术 喉返神经损伤 监测 手术中 

分 类 号：R736.1[医药卫生—肿瘤]