Clinical Efficacy of Recurrent Laryngeal Nerve Monitoring in Video-Assisted Thyroidectomy for Huge Thyroid Nodules_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HULi-ping ¹ , WANGHui ² , SHIYong-zhao ² ,  LIXue-qing ² , GAOBin ² , CHENGZhi-jian ²

1. Department of General Surgery, Central Hospital of Shanghai Minhang District, Shanghai 200240, China;
2. Department of General Surgery, The Fifth People's Hospital of Shanghai Fudan University, Shanghai 200240, China;

Corresponding?author：

LIXue-qing, Email: xueqli@163.com

Keywords：

Huge thyroid nodule; Recurrent laryngeal nerve monitoring; Video-assisted

DOI：

10.7507/1007-9424.20160154

Video：

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Objective To investigate effect of recurrent laryngeal nerve monitoring in video-assisted thyroidectomy for huge thyroid nodules. Methods The clinical data of 158 patients with huge thyroid nodules underwent videoassisted thyroidectomy from January 2013 to June 2015 were analyzed retrospectively, the recurrent laryngeal nerves were monitored in 79 cases (monitoring of recurrent laryngeal nerve group) while the recurrent laryngeal nerves were not monitored in the other patients (non-monitoring of recurrent laryngeal nerve group). The operative time, blood loss, postoperative drainage, postoperative hospital stay, and the incidences of transient and permanent recurrent laryngeal nerve injury were observed between these two groups. Results The video-assisted miniincision thyroidectomy was successfully completed in these 158 cases. Compared with the non-monitoring of recurrent laryngeal nerve group, the operative time (min) was shorter (76.2±23.4 versus 89.2±29.8, P < 0.05), the blood loss and the postoperative drainage were less (16.3±13.6 versus 20.6±10.7, P < 0.05; 20.7±9.6 versus 25.5±9.1, P < 0.05) in the monitoring of recurrent laryngeal nerve group. But the postoperative hospital stay (d) had no significant difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group (3.2±1.3 versus 3.3±1.9, P > 0.05). Eight weeks later, the incidence of transient recurrent laryngeal nerve injury in the monitoring of recurrent laryngeal nerve group was significantly lower than that in the non-monitoring of recurrent laryngeal nerve group [5.6% (5/90) versus 21.8% (17/78), P < 0.05], while the incidence of permanent nerve injury had no statistical difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group [0(0/90) versus 1.3% (1/78), P > 0.05]. Conclusion Recurrent laryngeal nerve monitoring under video-assisted thyroidectomy for huge thyroid nodules could effectively reduce incidence of nerve injury and shorten operation time.

Citation： HULi-ping, WANGHui, SHIYong-zhao, LIXue-qing, GAOBin, CHENGZhi-jian. Clinical Efficacy of Recurrent Laryngeal Nerve Monitoring in Video-Assisted Thyroidectomy for Huge Thyroid Nodules. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(5): 573-576. doi: 10.7507/1007-9424.20160154 Copy

1.	中華醫學會內分泌學分會, 中華醫學會外科學分會, 中國抗癌協會頭頸腫瘤專業委員會, 等.甲狀腺結節和分化型甲狀腺癌診治指南.中國腫瘤臨床雜志, 2012, 39(17):1248-1272.
2.	吳高松, 馬小鵬, 劉巖巖, 等.甲狀腺全切除術的技術改進(附252例報告).華中科技大學學報:醫學版, 2009, 38(6):829-831.
3.	Hermann M, Alk G, Roka R, et al. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases:effect of nerve dissection and impact of individual surgeon in more than 27000 nerves at risk. Ann Surg, 2002, 235(2):261-268.
4.	孫輝, 劉曉莉, 張大奇, 等.甲狀腺手術中喉返神經保護及監測的臨床應用.中國普外基礎與臨床雜志, 2010, 17(8):768-771.
5.	劉春萍, 黃韜.甲狀腺手術喉返神經損傷的原因及處理探討.中國普外基礎與臨床雜志, 2008, 15(5):314-317.
6.	陸深泉, 劉濤.復發性結節性甲狀腺腫再手術中預防喉返神經損傷的體會.中國普外基礎與臨床雜志, 2012, 19(7):777-778.
7.	曾繁余.分化型甲狀腺癌診治現狀及后指南時代的展望.中國普通外科雜志, 2013, 22(5):638-642.
8.	姜立新, 王東, 胡金晨, 等.術中喉返神經監測在復雜甲狀腺手術中的應用.中華內分泌外科雜志, 2012, 6(4):231-233.
9.	Touzopoulos P, Karanikas M, Zarogoulidis P, et al. Current surgical status of thyroid diseases. J Multidiscip Healthc, 2011, 4(3):441-449.
10.	魏濤, 李志輝, 朱精強.喉返神經探測儀實時監測在再次甲狀腺手術中的應用.中國普外基礎與臨床雜志, 2010, 17(8):772-774.
11.	董涇青, 雷尚通.甲狀腺手術中顯露喉返神經以避免喉返神經損傷的臨床意義.中國普外基礎與臨床雜志, 2012, 19(3):297-299.
12.	Lee YS, Nam KH, Chung WY, et al. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci, 2010, 25(4):541-545.
13.	陳季松, 張先林, 龔學東, 等.喉返神經顯露技術在甲狀腺手術中的應用.中國普通外科雜志, 2011, 20(11):1161-1163.
14.	馬仲福, 楊克虎, 王軍, 等.暴露與非暴露喉返神經的甲狀腺手術對術后喉返神經損傷影響的Meta分析.中國普通外科雜志, 2014, 23(5):647-652.
15.	Flisberg k, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl, 1969, 263(1):63-67.
16.	James AG, Crocker S, Woltering E, et al. A simple method for identifying and testing the recurrent laryngeal nerve. Surg Gynecol Obstet, 1985, 161(4):185-186.
17.	Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope, 1996, 106(7):443-449.
18.	Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement. Laryngoscope, 2011, 121(Suppl 1):S1-S16.
19.	Chiang FY, Lu IC, Tsai CJ, et al. Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury? Evidence from the application of intraoperative neuromonitoring. Am J Otolaryngol, 2011, 32(6):499-503.
20.	Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery:prospective evaluation of intraoperative electrophysiological responses for the prediction of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg, 2004, 240(1):9-17.
21.	Johnson S, Goldenberg D. Intraoperative monitoring of the recurrent laryngeal nerve during revision thyroid surgery. Otolaryngol Clin North Am, 2008, 41(6):1147-1154.
22.	Dionigi G, Boni L, Rovera F, et al. Neuromonitoring and videoassisted thyroidectomy:a prospective, randomized case-control evaluation. Surg Endosc, 2009, 23(5):996-1003.
23.	Ho Y, Carr MM, Goldenberg D. Trends in intraoperative neural monitoring for thyroid and parathyroid surgery amongst otolaryngologists and general surgeons. Eur Arch Otorhinolaryngol, 2013, 270(9):2525-2530.
24.	鄧先兆, 劉溦薇, 伍波, 等.甲狀腺癌術中喉返神經監測.中華內分泌外科雜志, 2014, 8(1):8-11.
25.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會.甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版).中國實用外科雜志, 2013, 33(6):470-474.
26.	姚永庭.顯露喉返神經在高風險甲狀腺手術中對喉返神經保護作用.中國普通外科雜志, 2015, 24(5):756-759.

1. 中華醫學會內分泌學分會, 中華醫學會外科學分會, 中國抗癌協會頭頸腫瘤專業委員會, 等.甲狀腺結節和分化型甲狀腺癌診治指南.中國腫瘤臨床雜志, 2012, 39(17):1248-1272.
2. 吳高松, 馬小鵬, 劉巖巖, 等.甲狀腺全切除術的技術改進(附252例報告).華中科技大學學報:醫學版, 2009, 38(6):829-831.
3. Hermann M, Alk G, Roka R, et al. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases:effect of nerve dissection and impact of individual surgeon in more than 27000 nerves at risk. Ann Surg, 2002, 235(2):261-268.
4. 孫輝, 劉曉莉, 張大奇, 等.甲狀腺手術中喉返神經保護及監測的臨床應用.中國普外基礎與臨床雜志, 2010, 17(8):768-771.
5. 劉春萍, 黃韜.甲狀腺手術喉返神經損傷的原因及處理探討.中國普外基礎與臨床雜志, 2008, 15(5):314-317.
6. 陸深泉, 劉濤.復發性結節性甲狀腺腫再手術中預防喉返神經損傷的體會.中國普外基礎與臨床雜志, 2012, 19(7):777-778.
7. 曾繁余.分化型甲狀腺癌診治現狀及后指南時代的展望.中國普通外科雜志, 2013, 22(5):638-642.
8. 姜立新, 王東, 胡金晨, 等.術中喉返神經監測在復雜甲狀腺手術中的應用.中華內分泌外科雜志, 2012, 6(4):231-233.
9. Touzopoulos P, Karanikas M, Zarogoulidis P, et al. Current surgical status of thyroid diseases. J Multidiscip Healthc, 2011, 4(3):441-449.
10. 魏濤, 李志輝, 朱精強.喉返神經探測儀實時監測在再次甲狀腺手術中的應用.中國普外基礎與臨床雜志, 2010, 17(8):772-774.
11. 董涇青, 雷尚通.甲狀腺手術中顯露喉返神經以避免喉返神經損傷的臨床意義.中國普外基礎與臨床雜志, 2012, 19(3):297-299.
12. Lee YS, Nam KH, Chung WY, et al. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci, 2010, 25(4):541-545.
13. 陳季松, 張先林, 龔學東, 等.喉返神經顯露技術在甲狀腺手術中的應用.中國普通外科雜志, 2011, 20(11):1161-1163.
14. 馬仲福, 楊克虎, 王軍, 等.暴露與非暴露喉返神經的甲狀腺手術對術后喉返神經損傷影響的Meta分析.中國普通外科雜志, 2014, 23(5):647-652.
15. Flisberg k, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl, 1969, 263(1):63-67.
16. James AG, Crocker S, Woltering E, et al. A simple method for identifying and testing the recurrent laryngeal nerve. Surg Gynecol Obstet, 1985, 161(4):185-186.
17. Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope, 1996, 106(7):443-449.
18. Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement. Laryngoscope, 2011, 121(Suppl 1):S1-S16.
19. Chiang FY, Lu IC, Tsai CJ, et al. Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury? Evidence from the application of intraoperative neuromonitoring. Am J Otolaryngol, 2011, 32(6):499-503.
20. Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery:prospective evaluation of intraoperative electrophysiological responses for the prediction of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg, 2004, 240(1):9-17.
21. Johnson S, Goldenberg D. Intraoperative monitoring of the recurrent laryngeal nerve during revision thyroid surgery. Otolaryngol Clin North Am, 2008, 41(6):1147-1154.
22. Dionigi G, Boni L, Rovera F, et al. Neuromonitoring and videoassisted thyroidectomy:a prospective, randomized case-control evaluation. Surg Endosc, 2009, 23(5):996-1003.
23. Ho Y, Carr MM, Goldenberg D. Trends in intraoperative neural monitoring for thyroid and parathyroid surgery amongst otolaryngologists and general surgeons. Eur Arch Otorhinolaryngol, 2013, 270(9):2525-2530.
24. 鄧先兆, 劉溦薇, 伍波, 等.甲狀腺癌術中喉返神經監測.中華內分泌外科雜志, 2014, 8(1):8-11.
25. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會.甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版).中國實用外科雜志, 2013, 33(6):470-474.
26. 姚永庭.顯露喉返神經在高風險甲狀腺手術中對喉返神經保護作用.中國普通外科雜志, 2015, 24(5):756-759.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Efficacy of Recurrent Laryngeal Nerve Monitoring in Video-Assisted Thyroidectomy for Huge Thyroid Nodules

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