Intraoperative Neuromonitoring Of The Recurrent Laryngeal Nerve In Reoperative Thyroid Surgery

Objective:To discuss the clinical value of intraoperative neuromonitoring(IONM)of the recurrent laryngeal nerve(RLN) in reoperative thyroidsurgery and the impact of temporary RLN injury on patients during theprocess of recovery.Method:The data of243patients who underwent reoperative thyroid surgeryin our department between October2011to October2013weresummarized.There were41patients with normal preoperativelaryngoscope result who were reoperated with the IONM—the nervemonitoring group.41patients with normal preoperative laryngoscoperesult who were reoperated by using the method of exposing RLNroutinely were selected as the control group—routine exposure groupvia the random number table method and the principle of1:1.The timefor RLN exposing, total operative time, RLN injury rate, intraoperativeblood loss,the ammount of postoperative drainage and thehospitalization cost were compared. The clinical value of intraoperativeneuromonitoring of the RLN in reoperative thyroid surgery werediscussed. The quality of life during the period of recovery of the19patients who suffered from transient RLN injury via QLQ-C30questionnaire was assessed.Results:Among the81patients: male13cases, female69cases; the ratio of male to female was1:5.31; the average age was (56.46±3.92);24cases ofbenign thyroid disease,58cases of papillary thyroid cancer; operationmode: unilateral subtotal resection in9cases, unilateral total resection in15cases, bilateral total resection and central lymph node dissection in28cases, bilateral total resection and central lymph node dissection+unilateral neck dissection in30cases; the side of the revealed RLN:71cases of left side,69cases of right side. RLN exposure time, totaloperative time, permanent and temporary RLN injury rate, average bloodloss, postoperative RLN injury rate of and hospital fee of the nervemonitoring group:(12.7±1.7) min，(129.5±4.3) min,5.63%,1.41%,(98.6±10.7) ml,(79.5±8.3) and (22725.3±143) yuan. RLN exposure time,total operative time, permanent and temporary RLN injury rate, averageblood loss, postoperative RLN injury rate of and hospitalization fee of theconventional expose group:(13.3±3.3) min，(137.4±9.3) min,21.74%,1.45%,(101.3±9.7) ml, ml (77.8±3.3) and (17307±114) yuan. Thetemporary RLN injury rate and hospitalization expense between the twogroups were statistically different (P<0.05). In order to effectivelyevaluate the value of RLN monitoring in predicting nerve injury, itssensitivity, specificity, positive predictive value and negative predictivevalue were calculated:80%，95.45%，57.14%，98.44%。The results ofQLQ-C30questionnaire showed that temporary RLN injury bring lots ofinconvenience to patients’ life and work,the quantity of their life wereadversely affected.Conclusion:In reoperative thyroid surgery, if the neuromonitoring of RLN isapplied, the rate of temporary RLN injury can be decreased. Despiteneurological function can be partly rehabilitated after the temporaryRLN injury, the quality of life were harmfully influenced during recovery period. Nerve monitoring is a reliable prediction ofpostoperative nerve function as well. Therefore, in reoperative thyroidsurgery, intraoperative RLN monitoring should be promoted.