Evidence-based Study On The Protection Of Recurrent Laryngeal Nerve During Thyroid

Background and purpose: With the change of disease spectrum and the change of social environment, the incidence of thyroid disease also increasing year by year.Most of the thyroid disease requires surgical treatment, the traditional surgical method including subtotal thyroidectomy, total thyroidectomy and thyroid radical resection,these are easily to recurrent laryngeal nerve injury in operation. The purpose of this study is to compare exposure versus non exposure recurrent laryngeal nerve thyroid surgery,completely endoscopic thyroidectomy versus modified Miccoli thyroidectomy and intraoperative nerve monitoring thyroid surgery versus exposure recurrent laryngeal nerve thyroid surgery, using effect of surgery and postoperative never injury rate, comprehensively evaluate the advantages and disadvantages of different methods respectively, finally provide a reference for clinicians during thyroid surgery.Methods: This article uses computer search and manual search to collect randomized controlled trials about exposure and non exposure of recurrent laryngeal nerve in thyroid surgery, completely endoscopic thyroidectomy and modified Miccoli thyroidectomy and postoperative nerve monitoring in thyroid surgery and exposure of recurrent laryngeal nerve in thyroid surgery, using a predetermined inclusion and exclusion criteria to screen literature. Then evaluate the quality of final literature and finally conduct Meta analysis.Results: This paper is divided into three parts: a meta analysis of exposure and non exposure of recurrent laryngeal nerve in thyroid surgery on postoperative recurrent laryngeal nerve injury(the first part); a meta analysis of completely endoscopic thyroid surgery and modified Miccoli surgery(the second part) and a meta analysis of intraoperative nerve monitoring operation and exposure of recurrent laryngeal nerve in thyroid surgery(the third part). The results show that: 1. The differences in exposure and non exposure of recurrent laryngeal nerve surgery in recurrent nerve temporary injury rate [OR=0.14,95%CI(0.06,0.34)] and the permanent injury rate[OR=0.14,95%CI(0.06,0.34)] are statistically significant. 2. The differences in totally endoscopic thyroid surgery and modified Miccoli surgery in operative time[MD=34.51,95%CI(17.48,51.55)], bleeding volume [MD=6.95,95%CI(0.57,13.34)]and postoperative drainage [MD=39.66,95%CI(24.80,54.51)] are statistical significance, while difference in recurrent nerve temporary injury rate[OR=1.01,95%CI(0.37,2.74)] is not significant. 3. The differences in intraoperative nerve monitoring and exposure of recurrent laryngeal nerve surgery in recurrent laryngeal nerve exploration time [MD=-5.68,95%CI(-7.71,-3.66)], operation time[MD=-21.14,95%CI(-35.57,-6.71)] and recurrent nerve temporary injury rate[OR=0.4,95%CI(0.25,0.63)] are statistically significant, while difference in recurrent nerve permanent injury rate [OR=0.64,95%CI(0.32,1.27)] is not significant.Conclusions: The main conclusions of this study: 1. Exposure of recurrent laryngeal nerve in thyroid surgery compared with traditional surgery with non exposed of RLN have lower temporary and permanent injury rate. 2. The modified Miccoli surgery compared with total endoscopic thyroid surgery have advantages of short operation time, less intraoperative bleeding and less operation drainage. 3. Intraoperative nerve monitoring surgery compared with exposure of recurrent laryngeal nerve surgery have shorter nerve exploration time and operation time,and the recurrent laryngeal nerve temporary injury rate is lower. 4. The choice of recurrent laryngeal nerve protection methods in thyroid surgery is flexible, operator should combine with the comprehensive analysis of many factors such as their clinics for medical conditions,thyroid disease type, thyroid lesion size and thyroid operation times, and reasonable choose the best method of operation.