术中神经监测技术在甲状腺手术中的应用价值

发布时间：2018-08-01 14:31

【摘要】：目的探讨甲状腺手术中神经监测技术(IONM)的应用价值。方法收集2015年8月至2016年10月在广西医科大学第一附属医院胃肠腺体外科行甲状腺手术且术前电子喉镜检查正常的445例患者资料。其中使用神经监测技术术中监测喉返神经213例,共探查显露喉返神经358条(神经监测组),术中常规显露喉返神经232例,显露喉返神经379条(常规显露组)。比较两组术后暂时性喉返神经损伤、永久性喉返神经损伤、手术时间、术中出血量、术后引流量、拔管时间、住院时间以及住院费用的差异。结果神经监测组暂时性RLN损伤率较常规显露组低,暂时性RLN损伤率分别为1.40%vs.5.28%,差异有统计学意义(P0.05),神经监测组永久性RLN损伤率也较常规显露组低,分别为0.28%vs.1.06%,但差异无统计学意义(P0.05);神经监测组手术时间、术中出血量、术后引流量、术后拔管时间及住院时间较常规显露组少,其中两组平均手术时间分别为163.71±79.26 min vs.192.62±100.60 min,差异有统计学意义(P0.05);两组平均术中出血量分别为36.77±29.85 ml vs.57.41±29.95 ml,差异有统计学意义(P0.05);两组平均术后引流量分别为59.81±53.49 ml vs.89.80±70.39 ml,差异有统计学意义(P0.05);两组平均术后拔管时间分别为2.16±1.31 d vs.3.16±1.18 d,差异有统计学意义(P0.05);两组平均住院时间分别为7.60 d±2.24 d vs.8.22±2.12 d,差异有统计学意义(P0.05)。神经监测组住院费用较常规显露组高,两组平均住院费用分别为2.08±0.33万元vs.1.70±0.34万元,差异有统计学意义(P0.05)。结论在甲状腺手术中应用IONM显露RLN与常规显露相比,可以降低RLN损伤率,加快手术进程,减少手术时间及术中出血,并减少术后引流量,提前拔管时间,减少住院时间,有利于术后恢复;在甲状腺手术中应用IONM费用较高,但患者一般均能接受该费用,从费用效益比考虑我们认为IONM在甲状腺手术中有较大应用价值。
[Abstract]:Objective to evaluate the value of nerve monitoring technique (IONM) in thyroid surgery. Methods 445 patients who underwent thyroid surgery in the first affiliated Hospital of Guangxi Medical University from August 2015 to October 2016 with normal preoperative electronic laryngoscopy were collected. Nerve monitoring technique was used to monitor recurrent laryngeal nerve in 213 cases. 358 recurrent laryngeal nerves were exposed (nerve monitoring group). 232 cases of recurrent laryngeal nerve and 379 recurrent laryngeal nerve (routine exposure group) were exposed during operation. The difference of temporary recurrent laryngeal nerve injury, permanent recurrent laryngeal nerve injury, operation time, intraoperative blood loss, postoperative drainage, extubation time, hospital stay and hospitalization cost were compared between the two groups. Results the rate of temporary RLN damage in the nerve monitoring group was lower than that in the conventional exposure group, and the damage rate of temporary RLN was 1.40 vs.5.28.The difference was statistically significant (P0.05). The permanent RLN damage rate in the nerve monitoring group was also lower than that in the conventional exposure group. There was no significant difference between the two groups (P0.05). The time of operation, blood loss, drainage, extubation and hospital stay were less in the nerve monitoring group than in the conventional exposure group. The mean operative time of the two groups was 163.71 卤79.26 min vs.192.62 卤100.60 minutes, the difference was statistically significant (P0.05), the mean intraoperative bleeding volume of the two groups was 36.77 卤29.85 ml vs.57.41 卤29.95 ml, respectively (P0.05); the mean postoperative drainage volume of the two groups was 59.81 卤53.49 ml vs.89.80 卤70.39 ml, respectively. The mean extubation time was 2.16 卤1.31d vs.3.16 卤1.18d in the two groups (P0.05), and the average hospitalization time was 7.60d 卤2.24d vs.8.22 卤2.12d in the two groups (P0.05). The average hospitalization cost of the nerve monitoring group was 2.08 卤3300 vs.1.70 卤3400 yuan, which was significantly higher than that of the conventional exposure group (P0.05). Conclusion IONM exposure of RLN in thyroid surgery can reduce the rate of RLN injury, speed up the process of operation, reduce the operative time and bleeding, reduce the drainage, remove the tube in advance, and reduce the hospital stay. The cost of using IONM in thyroid surgery is high, but the patients can generally accept the cost. We think that IONM has a great value in thyroid surgery from the cost-benefit ratio.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R653

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