Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database
Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database
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DOI：
10.1093/bjs/znaa081
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发表时间：
2021-01-26
影响因子：
9.6
通讯作者：
Aspinall, S.
中科院分区：
文献类型：
--
作者：
Abdelhamid, A.;Aspinall, S.
背景资料：术中神经监测（IONM）越来越多地用于甲状腺手术，以防止喉返神经（RLN）损伤，尽管缺乏确切的证据。本研究分析了英国内分泌和甲状腺手术登记处（UKRETS），以调查IONM是否降低RLN损伤的发生率。方法：UKRETS数据于2018年7月28日提取。分析了与喉返神经麻痹风险相关的因素，如年龄、性别、胸骨后甲状腺肿、再手术、能量器械的使用、手术范围、淋巴结清扫和IONM。排除了这些风险因素条目缺失的数据。术前和术后喉镜检查的患者的结果进行了分析。结果：喉返神经麻痹发生在甲状腺切除术的4.9%。64.6%的患者出现暂时性麻痹，35.4%的患者出现持续性麻痹。在多变量分析中，IONM降低了喉返神经麻痹的风险（比值比（OR）0.63，95%置信区间（CI）0.54至0.74，P < 0.001）和持续性神经麻痹（OR 0.47，0.37至0.61，P < 0.001）。门诊喉镜检查也与喉返神经麻痹的发生率降低相关（OR 0.50，0.37 ~ 0.67，P < 0.001）。双侧喉返神经麻痹的发生率为0.3%，再次手术（OR 12.30，2.90 ~ 52.10，P = 0.001）和甲状腺全切除术（OR 6.52，1.50 ~ 27.80，P = 0.010）与双侧喉返神经麻痹显著相关。基于UKRETS数据分析的这些结果支持在甲状腺手术中常规使用RLN监测。
Background: Intraoperative nerve monitoring (IONM) is used increasingly in thyroid surgery to prevent recurrent laryngeal nerve (RLN) injury, despite lack of definitive evidence. This study analysed the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to investigate whether IONM reduced the incidence of RLN injury.Methods: UKRETS data were extracted on 28 July 2018. Factors related to risk of RLN palsy, such as age, sex, retrosternal goitre, reoperation, use of energy devices, extent of surgery, nodal dissection and IONM, were analysed. Data with missing entries for these risk factors were excluded. Outcomes of patients who had preoperative and postoperative laryngoscopy were analysed.Results: RLN palsy occurred in 4.9 per cent of thyroidectomies. The palsy was temporary in 64.6 per cent and persistent in 35.4 per cent of patients. In multivariable analysis, IONM reduced the risk of RLN palsy (odds ratio (OR) 0.63, 95 per cent confidence interval (CI) 0.54 to 0.74, P < 0.001) and persistent nerve palsy (OR 0.47, 0.37 to 0.61, P < 0.001). Outpatient laryngoscopy was also associated with a reduced incidence of RLN palsy (OR 0.50, 0.37 to 0.67, P < 0.001). Bilateral RLN palsy occurred in 0.3 per cent. Reoperation (OR 12.30, 2.90 to 52.10, P = 0.001) and total thyroidectomy (OR 6.52, 1.50 to 27.80; P = 0.010) were significantly associated with bilateral RLN palsy.Conclusion: The use of IONM is associated with a decreased risk of RLN injury in thyroidectomy. These results based on analysis of UKRETS data support the routine use of RLN monitoring in thyroid surgery.