PDF(Pubmed)
Abstract：
Thyroid surgery is associated with a risk of injury to the recurrent laryngeal nerve, especially in the presence of anatomical variants such as a non-recurrent laryngeal nerve (NRLN). Injury to the nerve leads to transient or permanent vocal cord palsy (VCP). A novel method to prevent VCP is continuous intraoperative nerve monitoring (cIONM), but less is known about the applicability of this method in patients with NRLN. The aim of this study was to evaluate our own data regarding feasibility and detailed characteristics of cIONM in NRLN patients. We performed a monocentric retrospective cohort analysis including clinical data and intraoperative nerve monitoring data (measured by Inomed Medizintechnik GmbH, Emmendingen, \'C2\' and \'C2 Xplore\' device) of all thyroid surgery patients, showing NRLN between 2014 and 2022. Of 1406 patients who underwent thyroid surgery with cIONM between 2014 and 2022, 12 patients (0.9%) showed NRLN intraoperatively. Notably, cIONM was feasible in eight patients (67%). In all cases the onset latency of the right vagus nerve was shorter (<3.0 ms) than usually expected, suggesting that a short latency might be suitable to distinguish NRLN. None of the patients had a post-operative VCP. Overall, cIONM appears to be feasible and safe in NRLN patients and provides helpful information to prevent VCP.
摘要：
甲状腺手术与喉返神经损伤的风险有关，特别是在存在解剖变体的情况下，例如非返喉神经（NRLN）。神经损伤导致短暂性或永久性声带麻痹(VCP)。预防VCP的新方法是连续术中神经监测（cIONM），但对该方法在NRLN患者中的适用性知之甚少。这项研究的目的是评估我们自己的数据有关NRLN患者cIONM的可行性和详细特征。我们进行了单中心回顾性队列分析，包括临床数据和术中神经监测数据（由InomedMedizintechnikGmbH测量，Emmendingen,所有甲状腺手术患者的\'C2\'和\'C2Xplore\'装置)，在2014年至2022年之间显示NRLN。在2014年至2022年间接受cIONM甲状腺手术的1406例患者中，有12例（0.9％）在术中显示NRLN。值得注意的是,cIONM在8例患者(67%)中是可行的。在所有情况下，右迷走神经的发作潜伏期比通常预期的要短（<3.0ms），提示短潜伏期可能适合区分NRLN。没有患者有术后VCP。总的来说,cIONM在NRLN患者中似乎是可行和安全的，并提供了预防VCP的有用信息。
