标题：术中喉返神经监测在甲状腺再次手术中的应用

      作者：万月明 1，占顺堂 2，肖社平 2，磨鹏诗 1    (佛山市顺德区乐从医院广州医科大学附属顺德医院普外科 1、耳鼻喉科 2，广东 佛山 528315)

      卷次： 2018年29卷11期

      【摘要】 目的 探讨术中喉返神经监测(IONM)在甲状腺再次手术患者中的应用价值。方法 选择2015年2月至2017年5月佛山市顺德区乐从医院普外科甲状腺再次手术患者100例以随机数表法分为观察组与对照组各50例，观察组给予 IONM，对照组给予喉返神经(RLN)常规显露，比较两组患者RLN识别率、RLN确认时间、平均手术时间、术中出血量、术后引流量、RLN损伤率。结果 观察组患者RLN识别率为 100.0%，明显高于对照组的84.0%，差异有统计学意义(P<0.05)；观察组患者的 RLN确认时间、平均手术时间明显短于对照组，术中出血量、术后引流量明显少于对照组，差异均有统计学意义(P<0.05)；观察组患者的暂时性 RLN损伤率为 0，显著低于对照组的 22.0%，术后 1年的 RLN损伤率为 0，显著低于对照组的 16.0%，差异均有显著统计学意义(P<0.01)。结论 甲状腺再次手术实施 IONM可显著提高 RLN 识别率，RLN确认时间短，手术时间短，出血量少，RLN损伤率低。
      【关键词】 甲状腺；术中喉返神经监测；喉返神经
      【中图分类号】 R653 【文献标识码】 A 【文章编号】 1003—6350（2018）11—1597—03

Value of intraoperative nerve monitoring in reoperation of thyroid.
WAN Yue-ming 1, ZHANG Shun-tang 2, XIAOShe-ping 2, MO Peng-shi 1. Department of General Surgery 1, Department of ENT 2, Lecong Hospital of Shunde District ofFoshan (Shunde Hospital of Guangzhou Medical University), Foshan 528315, Guangdong, CHINA
【Abstract】 Objective To discuss the value of intraoperative nerve monitoring (IONM) in reoperation of thy-roid. Methods A total of 100 patients, who underwent reoperation of thyroid in Department of General Surgery ofLecong Hospital of Shunde District of Foshan during February 2015 to May 2017, were selected and divided into the ob-servation group (n=50) and the control group (n=50). The observation group was given IONM, and the control groupwas given routine exposure of recurrent laryngeal nerve. The recurrent laryngeal nerve (RLN) recognition rate, RLN con-firmation time, average operation time, intraoperative bleeding volume, postoperative flow rate and RLN damage ratewere compared between the two groups. Results The RLN recognition rate was 100.0% in the observation group,which was significantly higher than 84.0% in the control group (P<0.05); the RLN confirm time and average operationtime in the observation group were significantly shorter than those in the control group (P<0.05); the amount of intraop-erative bleeding and postoperative drainage volume were significantly less than those in the control group (P<0.05); theRLN temporary injury rate in the observation group was 0, which was significantly lower than 22.0% in the controlgroup (P<0.05); the permanent RLN injury rate (1 year after the operation) of the observation group was 0, which wassignificantly lower than 16.0% of the control group (P<0.01). Conclusion In reoperation of thyroid, IONM can signifi-cantly improve the recognition rate of RLN, with low RLN recognition time, short operation time, less bleeding amount,and low RLN damage rate.
      【Key words】 Thyroid; Intraoperative nerve monitoring (IONM); Recurrent laryngeal nerve (RLN)·临床经验·doi:10.3969/j.issn.1003-6350.2018.11.036基金项目：广东省佛山市医学类科技攻关项目资助(编号：0006275120428014)