■尽管术中神经监测(IONM)在甲状腺手术中已经确立,在甲状旁腺手术中分析较少。这项研究介绍了IONM用于原发性和继发性甲状旁腺功能亢进手术的结果。
■我们回顾性评估了270例原发性甲状旁腺功能亢进(PHPT)患者,53例继发性甲状旁腺功能亢进(SHPT),2010年6月至2022年6月在中国一家医院就诊的300例甲状腺癌患者。随访12个月。人口统计,来自IONM的肌电图数据,实验室,并收集临床资料。喉镜检查是从109例未使用IONM的PHPT患者中收集的。采用Pearson卡方检验和Fisher精确概率法对各组进行评估,以验证甲状旁腺大小与位置的关系。手术持续时间,术前一致定位,喉痛,IONM结果,治愈率,和RLN受伤。视觉模拟量表(VAS)评估喉痛。根据神经风险(NAR)测量RLN结果。
■这项研究理解了918NAR,PHPT的NAR为272、105、109和432,SHPTwithIONM,没有IONM的PHPT,甲状腺手术对照组,分别。IONM成功预防了RLN损伤(P<0.001,P=0.012):手术期间有15个(5.51%)RLN经历了神经肌电图改变,PHPT患者中有5例(1.84%)发生一过性RLN损伤。五个(4.76%)RLN在手术过程中发现改变了EMG特征,在SHPT患者中,有1例(0.95%)RLN出现一过性RLN损伤。本系列无永久性神经损伤(0.00%)。位置之间没有关联,腺体大小,术前一致定位,治愈率,手术持续时间,和IONM(P>0.05)。手术时间与术后咽部不适相关(P=0.026,P=0.024)。接受IONM的PHPT患者的暂时性RLN损伤明显低于未接受IONM的患者。术中神经监测对喉返神经有保护作用(P=0.035)。与甲状旁腺切除术相比,甲状腺切除术的RLN损伤发生率较高(5.32%,P<0.001)。
■用于SHPT和PHPT的IONM可提供快速的解剖腺体识别和RLN功能结果,以实现有效的RLN保护并降低RLN损伤率。
Although intraoperative neural monitoring (IONM) is well established in thyroid surgery, it is less commonly analyzed in parathyroid operations. This study presents the results of IONM for primary and secondary hyperparathyroidism surgery.
We retrospectively assessed 270 patients with primary hyperparathyroidism (PHPT), 53 patients with secondary hyperparathyroidism (SHPT), and 300 patients with thyroid cancer from June 2010 to June 2022 in one hospital in China. The follow-up was 12 months. Demographic, electromyography data from IONM, laboratory, and clinical information were collected. Laryngoscopy was collected from 109 patients with PHPT in whom IONM was not used. All groups were assessed by Pearson\'s chi-square test and Fisher\'s exact probability method to verify the relationship between parathyroid size and location, duration of surgery, preoperative concordant localization, laryngeal pain, IONM outcomes, cure rate, and RLN injury. Visual analog scale (VAS) assessed laryngeal pain. RLN outcomes were measured according to nerves at risk (NAR).
The study comprehended 918 NAR, that is 272, 105, 109, and 432 NAR for PHPT, SHPT with IONM, PHPT without IONM, and thyroid surgery control group, respectively. IONM successfully prevented RLN injury (P<0.001, P=0.012): Fifteen (5.51%) RLNs experienced altered nerve EMG profiles during surgery, and five (1.84%) experienced transient RLN injury in PHPT patients. Five (4.76%) RLNs were found to have altered EMG profiles during surgery, and one (0.95%) RLN had a transient RLN injury in SHPT patients. There was no permanent nerve injury (0.00%) in this series. There was no association between location, gland size, preoperative concordant localization, cure rate, duration of surgery, and IONM (P >0.05). Duration of surgery was associated with postoperative pharyngeal discomfort (P=0.026, P=0.024). Transient RLN injury was significantly lower in patients with PHPT who underwent IONM than in those who did not. Intraoperative neuromonitoring played an effective role in protecting the recurrent laryngeal nerve (P=0.035). Compared with parathyroidectomy, thyroidectomy had a higher rate of RLN injury (5.32%, P<0.001).
IONM for SHPT and PHPT offers rapid anatomical gland identification and RLN functional results for effective RLN protection and reduced RLN damage rates.