| Objectives To explore the clinical value of intraoperative neuromonitoring(IONM)in thyroid surgery by applying IONM to thyroid papillary carcinoma(PTC).Methods A total of 146 patients(RLN and EBSLN 252 branches each)who underwent open thyroid surgery and were confirmed to be PTC were enrolled in the Department of Glandular surgery of Hebei General Hospital from December 2017 to June 2019.According to whether or not to use of IONM,the patients were divided into observation group(95 cases,RLN and EBSLN 165 branches each)and control group(51 cases,RLN and EBSLN 87 branches each).The data of this study were statistically analyzed by IBM SPSS Statistics version 26.0 software.The measurement data were statistically analyzed by two independent sample t-test.The counting data were statistically analyzed by chi-square test or Fisher exact probability method.When the test standard was P<0.05,there was statistical difference.1.The time of finding and locating RLN was compared between the observation group and the control group.2.The overall injury rate,temporary injury rate and permanent injury rate of RLN in the observation group and the control group were compared.3.The overall injury rate,temporary injury rate and permanent injury rate of RLN(CLND-RLN)affected by central lymph node dissection and RLN(N-CLND-RLN)not affected by central lymph node dissection were compared between the observation group and the control group.4.The overall damage rate,temporary damage rate and permanent damage rate of CLND-RLN and N-CLND-RLN in the observation group and the control group were compared respectively.5.The relationship between the changes of RLN amplitude during operation and the changes of neurological function after operation were compared in the observation group.6.The EBSLN recognition rates in the observation group and the control group were compared.7.The EBSLN damage rates in the observation group and the control group were compared.Results 1.There was a significant difference in the time of finding and locating RLN(20.05±3.29 min /21.62±3.30 min,P<0.05)between the observation group and the control group.2.There was no significant difference between the observation group and the control group :total injury rate(2.4% /5.7%,P>0.05),temporary injury rate(2.4% /4.6%,P>0.05)and permanent injury rate(0 /1.1%,P>0.05).3.There was no significant difference between the observation group and the control group in the total CLND-RLN: injury rate(3.1% / 6.3%,P>0.05),temporary injury rate(3.1% / 4.7%,P>0.05)and permanent injury rate(0/1.6%,P>0.05).There was no significant difference between the observation group and the control group in the total N-CLND-RLN: injury rate(0 /4.3%,P>0.05),temporary injury rate(0 /4.3%,P>0.05)and permanentinjury rate(0/0).4.In the observation group,there was no significant difference in the total injury rate(3.1% / 0,P>0.05),temporary injury rate(3.1% / 0,P>0.05)and permanent injury rate(0/0,P>0.05)between CLND-RLN and N-CLND-RLN.In the control group,there was no significant difference in the total injury rate(6.3% / 4.3%,P > 0.05),the temporary injury rate(4.7% / 4.3%,P>0.05)and the permanent injury rate(1.6% / 0,P>0.05)between CLND-RLN and N-CLND-RLN.5.In order to evaluate the clinical value of IONM in the observation group for RLN injury,the sensitivity was 75%,the specificity was 98.8%,the negative predictive rate was 99.4%,and the positive predictive rate was60%.6.There was a significant difference in EBSLN recognition rate(89.1% /52.9%,P<0.05)between the observation group and the control group.7.There was significant difference in the total damage rate of EBSLN(3.3% /15.2%,P < 0.05)between the observation group and the control group.There was no statistically significant difference between the observation group and the control group in the injury rate of EBSLN of operation A(0/14.3%,P>0.05)and EBSLN of operation B/C(4.5% /15.6%,P>0.05).Conclusions 1.IONM technique can shorten the time of finding and locating RLN in thyroid surgery.2.According to the change of EMG amplitude during RLN,the information of RLN injury during operation can be provided and the postoperative RLN function can be predicted,so that when nerve injury occurs,corresponding repair and remedial measures can be taken during or after operation to minimize nerve injury.3.IONM technique can improve the recognition rate of EBSLN in thyroid surgery and reduce its damage rate.Figure [6];Table[14];Reference [222]... |
