Abstract：
Background and Objectives: Recurrent laryngeal nerve (RLN) paralysis is a fearful complication during thyroidectomy. Intraoperative neuromonitoring (IONM) and optical magnification (OM) facilitate RLN identification and dissection. The purpose of our study was to evaluate the influence of the two techniques on the incidence of RLN paralysis and determine correlations regarding common outcomes in thyroid surgery. Materials and Methods: Two equally sized groups of 50 patients who underwent total thyroidectomies were examined. In the first group (OM), only surgical binocular loupes (2.5×−4.5×) were used during surgery, while in the second group (IONM), the intermittent NIM was applied. Results: Both the operative time and the length of hospitalization were shorter in the OM group than in the IONM group (median 80 versus 100 min and median 2 versus 4 days, respectively) (p < 0.05). The male patients were found to have a five-fold higher risk of developing transient dysphonia than the females (adjusted OR 5.19, 95% IC 0.99−27.18, p = 0.05). The OM group reported a four-fold higher risk of developing transient hypocalcemia than the IONM group (OR 3.78, adjusted OR 4.11, p = 0.01). Despite two cases of temporary bilateral RLN paralysis in the IONM group versus none in the OM group, no statistically significant difference was found (p > 0.05). No permanent RLN paralysis or hypoparathyroidism have been reported. Conclusions: Despite some limitations, our study is the first to compare the use of IONM with OM alone in the prevention of RLN injuries. The risk of recurrent complications remains comparable and both techniques can be considered valid instruments, especially if applied simultaneously by surgeons.
摘要：
背景与目的：喉返神经（RLN）麻痹是甲状腺切除术中一种可怕的并发症。术中神经监测（IONM）和光学放大（OM）有助于RLN识别和解剖。我们研究的目的是评估两种技术对RLN麻痹发生率的影响，并确定甲状腺手术中常见结局的相关性。材料和方法：对两组大小相等的50例接受全甲状腺切除术的患者进行了检查。在第一组(OM)中，手术期间仅使用手术双目放大镜（2.5×-4.5×），而在第二组（IONM）中，间歇性NIM被应用。结果：OM组的手术时间和住院时间均短于IONM组（中位数80对100分钟，中位数2对4天，分别)(p<0.05)。发现男性患者发生短暂性发声障碍的风险比女性高五倍（校正OR5.19，95％IC0.99-27.18，p=0.05）。OM组报告发生短暂性低钙血症的风险比IONM组高4倍（OR3.78，校正OR4.11，p=0.01）。尽管IONM组有两例暂时性双侧RLN瘫痪，而OM组则没有，差异无统计学意义(p>0.05)。没有永久性RLN麻痹或甲状旁腺功能减退的报道。结论：尽管有一些限制，我们的研究首次比较了IONM和OM在预防RLN损伤中的应用.复发并发症的风险仍然相当，两种技术都可以被认为是有效的工具，特别是如果外科医生同时使用。
