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.	中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等.甲状腺结节和分化型甲状腺癌诊治指南.中国肿瘤临床杂志, 2012, 39(17):1248-1272.
2.	吴高松, 马小鹏, 刘岩岩, 等.甲状腺全切除术的技术改进(附252例报告).华中科技大学学报:医学版, 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.	孙辉, 刘晓莉, 张大奇, 等.甲状腺手术中喉返神经保护及监测的临床应用.中国普外基础与临床杂志, 2010, 17(8):768-771.
5.	刘春萍, 黄韬.甲状腺手术喉返神经损伤的原因及处理探讨.中国普外基础与临床杂志, 2008, 15(5):314-317.
6.	陆深泉, 刘涛.复发性结节性甲状腺肿再手术中预防喉返神经损伤的体会.中国普外基础与临床杂志, 2012, 19(7):777-778.
7.	曾繁余.分化型甲状腺癌诊治现状及后指南时代的展望.中国普通外科杂志, 2013, 22(5):638-642.
8.	姜立新, 王东, 胡金晨, 等.术中喉返神经监测在复杂甲状腺手术中的应用.中华内分泌外科杂志, 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.	魏涛, 李志辉, 朱精强.喉返神经探测仪实时监测在再次甲状腺手术中的应用.中国普外基础与临床杂志, 2010, 17(8):772-774.
11.	董泾青, 雷尚通.甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义.中国普外基础与临床杂志, 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.	陈季松, 张先林, 龚学东, 等.喉返神经显露技术在甲状腺手术中的应用.中国普通外科杂志, 2011, 20(11):1161-1163.
14.	马仲福, 杨克虎, 王军, 等.暴露与非暴露喉返神经的甲状腺手术对术后喉返神经损伤影响的Meta分析.中国普通外科杂志, 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.	邓先兆, 刘溦薇, 伍波, 等.甲状腺癌术中喉返神经监测.中华内分泌外科杂志, 2014, 8(1):8-11.
25.	中国医师协会外科医师分会甲状腺外科医师委员会.甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版).中国实用外科杂志, 2013, 33(6):470-474.
26.	姚永庭.显露喉返神经在高风险甲状腺手术中对喉返神经保护作用.中国普通外科杂志, 2015, 24(5):756-759.

1. 中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等.甲状腺结节和分化型甲状腺癌诊治指南.中国肿瘤临床杂志, 2012, 39(17):1248-1272.
2. 吴高松, 马小鹏, 刘岩岩, 等.甲状腺全切除术的技术改进(附252例报告).华中科技大学学报:医学版, 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. 孙辉, 刘晓莉, 张大奇, 等.甲状腺手术中喉返神经保护及监测的临床应用.中国普外基础与临床杂志, 2010, 17(8):768-771.
5. 刘春萍, 黄韬.甲状腺手术喉返神经损伤的原因及处理探讨.中国普外基础与临床杂志, 2008, 15(5):314-317.
6. 陆深泉, 刘涛.复发性结节性甲状腺肿再手术中预防喉返神经损伤的体会.中国普外基础与临床杂志, 2012, 19(7):777-778.
7. 曾繁余.分化型甲状腺癌诊治现状及后指南时代的展望.中国普通外科杂志, 2013, 22(5):638-642.
8. 姜立新, 王东, 胡金晨, 等.术中喉返神经监测在复杂甲状腺手术中的应用.中华内分泌外科杂志, 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. 魏涛, 李志辉, 朱精强.喉返神经探测仪实时监测在再次甲状腺手术中的应用.中国普外基础与临床杂志, 2010, 17(8):772-774.
11. 董泾青, 雷尚通.甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义.中国普外基础与临床杂志, 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. 陈季松, 张先林, 龚学东, 等.喉返神经显露技术在甲状腺手术中的应用.中国普通外科杂志, 2011, 20(11):1161-1163.
14. 马仲福, 杨克虎, 王军, 等.暴露与非暴露喉返神经的甲状腺手术对术后喉返神经损伤影响的Meta分析.中国普通外科杂志, 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. 邓先兆, 刘溦薇, 伍波, 等.甲状腺癌术中喉返神经监测.中华内分泌外科杂志, 2014, 8(1):8-11.
25. 中国医师协会外科医师分会甲状腺外科医师委员会.甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版).中国实用外科杂志, 2013, 33(6):470-474.
26. 姚永庭.显露喉返神经在高风险甲状腺手术中对喉返神经保护作用.中国普通外科杂志, 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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