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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 value of intraoperative nerve monitoring (IONM) in the prevention of recurrent laryngeal nerve (RLN) injury during reoperation of thyroid cancer. METHODS: Thirty-seven patients undergoing reoperation for thyroid cancer between January 2012 and December 2014 were selected, of whom 41 underwent RLN visualization (control group) and 96 underwent RLN visual recognition + IONM (study group) . The differences of RLN identification, injury rate, average operation time, postoperative drainage and parathyroid injury rate were compared between the two groups. Results: The RLN recognition rate was 100% (96/96) in the study group and 82.3% (34/41) in the control group, the difference was statistically significant (P <0.05). Compared with the control group, RLN injury rate was 1.0% vs.9.8%), and postoperative drainage volume (38.1 mL vs.44.1 mL) were significantly lower (all P <0.05). There was no significant difference between the two groups in the parathyroid injury rate (8.3% vs.12.2%, P > 0.05). Conclusion: The application of IONM can better improve the recognition rate of RLN and reduce the damage rate of RLN during reoperation of thyroid cancer, and reduce the postoperative complications.