| Objective: In recent years,thyroid carcinoma is increasing in incidence all over the world.Although thyroid cancer can be treated by surgery,endocrine therapy,iodine-131 therapy and targeted therapy,surgical treatment is the main treatment for thyroid cancer.Papillary thyroid carcinoma(PTC)is the most important pathological type,and its biological characteristic is that cervical lymph node metastasis is the mainly metastasis method.Some guidelines recommend a residue-free dissection of cervical lymph nodes on the basis of the protection of the recurrent laryngeal nerve(RLN).The identification and protection of the RLN have been the key points and difficulties of the thyroid cancer surgery.And the intraoperative injury of RLN has also been one of the major complications of this surgery.In order to reduce the occurrence of intraoperative RLN injury,many experts and scholars have proposed a series of technical methods.Intraoperative neuro monitoring(IONM)is gradually used in clinical as recurrent laryngeal nerve(RLN)function protection of new technology.However,its role in the prevention of RLN injury in thyroid cancer patients is still lacking evidence-based evidence at home and abroad.In this paper,the clinical value of IONM in PTC patients was analyzed to explore: 1)whether the application of IONMtechnology can reduce the rate of RLN injury in PTC patients;2)whether the application of IONM technology can shorten the operation time and improve the operation efficiency.Methods: We collected a total of 253 PTC patients and a total of 405 RLNs were exposed anatomically from May 2018 to July 2018.According to whether use of IONM or not,the patients were divided into two groups: the neuro monitoring group and the neuro exposure group.There were 119 cases in the nerve monitoring group,and 190 RLNs were exposed anatomically.In 134 cases of nerve exposure group,215 RLNs were exposed anatomically.Retrospective analysis was performed to compare the differences between the two groups in total RLN injury,permanent RLN injury,temporary RLN injury,search time of recurrent laryngeal nerve,operation time,and intraoperative bleeding volume.Results: Among 253 PTC patients,a total of 405 RLNs were exposed anatomically,including 101 cases of unilateral exposure and 152 cases of bilateral exposure.Among the 119 cases in the neuro monitoring group,a total of 190 RLNs were exposed anatomically,including 48 cases of unilateral exposure and 71 cases of bilateral exposure.There were 215 cases in the nerve exposure group,including 53 cases of unilateral exposure and 81 cases of bilateral exposure.In terms of the total RLN injury rate,the nerve monitoring group and the nerve exposure group were1.05%(2/190)and 6.05%(13/215),respectively,with statistical significance(P<0.05).In terms of the permanent RLN injury rate,the nerve monitoring group and the nerve exposure group were 0.00%(0/190)and 0.93%(2/215),respectively,without statistical significance(P>0.05).In terms of the temporary RLN injury rate,the nerve monitoring group and the nerve exposure group were 1.05%(2/190)and 5.12%(11/215),respectively,with statistical significance(P<0.05).At the same time,in termsof the time to search for recurrent laryngeal nerve,the nerve monitoring group and the nerve exposure group were 17.77±2.37 minutes and 18.67±1.50 minutes,respectively,with statistical significance(P<0.05).In terms of operation time,the neuro monitoring group and the nerve exposure group were 94.24±42.1 minutes and 110.30±46.63 minutes,respectively,which also had statistical significance(P<0.05).However,in terms of blood loss,the nerve monitoring group and the nerve exposure group were22.97±13.38 ml and 25.37±15.90 ml,respectively,but there was no statistical significance(P>0.05).Conclusion: Intraoperative recurrent laryngeal nerve monitoring technology can effectively reduce the rate of total recurrent laryngeal nerve injury,temporary recurrent laryngeal nerve injury rate,search for recurrent laryngeal nerve time and operation time in PTC patients undergoing combined radical resection of thyroid cancer.This technology is safe and reliable,with obvious advantages,and is worthy of clinical promotion!... |
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