PDF(Sci-hub)
Abstract：
Neuromonitoring has proved to be a useful technique in reducing nerve injury during thyroid surgery; however, costs continue to limit its use in resource-constrained settings. This study was done to assess the functional integrity of the recurrent laryngeal nerve (RLN) during thyroid surgery using palpation assessment of posterior cricoarytenoid muscle twitch in response to RLN stimulation. Between August 2016 and July 2017, 24 patients with 47 nerves at risk (NARs) underwent thyroid surgery with visual identification and testing of 44 RLNs. The functional integrity of the RLN was checked by stimulation of the RLN. Intraoperative assessment showed 100% sensitivity and positive predictive value in predicting postoperative vocal cord function. The postoperative vocal cord assessment confirmed all 44 nerves tested to be normally functioning. The mean (standard deviation) peak-to-peak amplitude and latency of the CMAP were 0.889 (0.740)/1.336 (1.660) mV and 2.295 (0.319)/2.217 (0.393) ms for left/right side NARs, respectively, with no statistically significant difference (P > 0.05). Palpation assessment of the posterior cricoarytenoid muscle provides a simple and reliable technique for confirming integrity of the RLN. Combining palpation assessment with CMAP from the inferior constrictor muscle may help reduce potential false negative results. With the use of our in-house built device which is significantly cheaper than the commercial ones, this could be considered a low-cost alternative to current established techniques.
摘要：
神经监测已被证明是减少甲状腺手术期间神经损伤的有用技术；然而，成本继续限制其在资源受限的环境中的使用。这项研究是为了评估甲状腺手术期间喉返神经（RLN）的功能完整性，使用触诊评估环后肌对RLN刺激的反应。在2016年8月至2017年7月之间，有47个神经风险（NAR）的24名患者接受了甲状腺手术，并对44个RLN进行了视觉识别和测试。通过RLN的刺激检查RLN的功能完整性。术中评估显示对预测术后声带功能具有100％的敏感性和阳性预测值。术后声带评估证实所有44条神经均正常运作。CMAP的平均（标准偏差）峰峰值幅度和延迟分别为0.889（0.740）/1.336（1.660）mV和2.295（0.319）/2.217（0.393）ms，分别,差异无统计学意义(P>0.05)。对环蝶骨后肌的触诊评估提供了一种简单可靠的技术来确认RLN的完整性。将触诊评估与下收缩肌的CMAP相结合可能有助于减少潜在的假阴性结果。通过使用我们的内置设备，该设备比商用设备便宜得多，这可以被认为是当前既定技术的低成本替代方案。
