Clinical outcome of continuous facial nerve monitoring during primary parotidectomy.

Clinical outcome of continuous facial nerve monitoring during primary parotidectomy.
复制标题

初次腮腺切除术期间连续面神经监测的临床结果。

DOI：
10.1001/archotol.1997.01900100055008
复制
发表时间：
1997
期刊：
Archives of Otolaryngology - Head and Neck Surgery
影响因子：
--
通讯作者：
G. Wolf
G. Wolf
中科院分区：
--
文献类型：
--
作者：
J. Terrell;P. Kileny;C. Yian;R. Esclamado;C. Bradford;Matthew S. Pillsbury;G. Wolf

文献摘要

被引文献

相似文献

目标 评估腮腺切除术期间持续面神经监测与无监测腮腺切除术相比是否与面神经轻瘫或麻痹的发生率较低相关，并评估此类监测的成本。 设计 回顾性分析腮腺切除术患者在有或无持续面神经监测的情况下的结局。 设置 大学医疗中心 患者 接受腮腺切除术的五十六例患者中使用了连续肌电图监测，61例患者中未使用。 主要观察指标 (1)早期和持续性面神经轻瘫或麻痹的发生率和（2）与面神经监测相关的费用。 结果 通过肌电监测的组（43.6%）的早期无意面部无力明显低于未监测组（62.3%）（P= 0.04）。在没有合并症或手术的患者亚组中，监测组的早期虚弱（33.3%）在统计学上仍然低于未监测组的早期虚弱率（57.5%）（P= 0.03）。各组或亚组之间的最终面神经功能或永久性神经损伤的发生率无统计学差异。多变量分析后，未监测状态（比值比[OR]，3.22）、年龄增长（OR，1.47/10岁）和手术时间延长（OR，1.3/小时）是与术后早期面部无力显著相关的唯一显著独立预测变量。面神经监测的增量成本为379美元。 结论 结果表明，在初次腮腺切除术期间对面部肌肉进行连续肌电监测可以减少术后短期面部麻痹的发生率。在决定常规使用连续监测是否是腮腺手术的有用、经济的辅助手段时，需要考虑该技术的优点和缺点以及额外的费用。
OBJECTIVES To assess whether continuous facial nerve monitoring during parotidectomy is associated with a lower incidence of facial nerve paresis or paralysis compared with parotidectomy without monitoring and to assess the cost of such monitoring. DESIGN A retrospective analysis of outcomes for patients who underwent parotidectomy with or without continuous facial nerve monitoring. SETTING University medical center. PATIENTS Fifty-six patients undergoing parotidectomy in whom continuous electromyographic monitoring was used and 61 patients in whom it was not used. MAIN OUTCOME MEASURES (1) The incidence of early and persistent facial nerve paresis or paralysis and (2) the cost associated with facial nerve monitoring. RESULTS Early, unintentional facial weakness was significantly lower in the group monitored by electromyograpy (43.6%) than in the unmonitored group (62.3%) (P=.04). In the subgroup of patients without comorbid conditions or surgeries, early weakness in the monitored group (33.3%) remained statistically lower than the rate of early weakness in the unmonitored group (57.5%) (P=.03). There was no statistical difference in the final facial nerve function or incidence of permanent nerve injury between the groups or subgroups. After multivariate analysis, nonmonitored status (odds ratio [OR], 3.22), advancing age (OR, 1.47 per 10 years), and longer operative times (OR, 1.3 per hour) were the only significant independent predictive variables significantly associated with early postoperative facial weakness. The incremental cost of facial nerve monitoring was $379. CONCLUSIONS The results suggest that continuous electromyographic monitoring of facial muscle during primary parotidectomy reduces the incidence of short-term postoperative facial paresis. Advantages and disadvantages of this technique need to be considered together with the additional costs in deciding whether routine use of continuous monitoring is a useful, cost-effective adjunct to parotid surgery.