The Clinical Application Of Intraoperative Neuromonitoring In Thyroidectomy

Objective:To evaluate the clinical value of intraoperative neuromonitoring in thyroidectomy.Methods:370 patients who underwent thyroidectomy in the second hospital of shanxi medical university from January 2016 to September 2018 were retrospectively analyzed and divided into the observation group(179 cases)and the control group(191 cases)according to whether introperative neuromonitoring was used.The rate of RLN injury after subtotal thyroidectomy of benign tumors was compared between the observation group and the control group.The rate of RLN injury after total thyroidectomy of benign tumors was compared between the observation group and the control group.The rates of RLN injury after total thyroidectomy and cervical lymph node dissection of malignant tumors were compared between the observation group and the control group.The operation time and cost were compared between the observation group and the control group.The relationship between the amplitude of RLN emg changes and postoperative symptoms of RLN injury in the observation group was compared.By recording the emg and cricothyroid muscle tremor results of EBSLN monitoring in the observation group,the recognition rate of EBLSN in the observation group and the control group was compared.Results:There was no statistically significant difference in the rate of temporary injury of RLN(0/0,P > 0.05)between the observation group and the control group after subtotal resection of benign tumors.There was no statistically significant difference in the rate of permanent injury of RLN(0/0,P > 0.05)between the observation group and the control group after subtotal resection of benign tumors.There was statistically significant difference in the rate of temporary injury of RLN(2.63% / 10.47%,P < 0.05)between the observation group and the control group after total resection of benign tumors.There was no statistically significant difference in the rate of permanent injury of RLN(0/0,P > 0.05)between the observation group and the control group after total resection of benign tumors.The rate of temporary injury of RLN after total thyroidectomy and cervical lymph node dissection for malignant tumors in the observation group and the control group(2.94% / 12.16,P < 0.05)was statistically significant.The rate of permanent injury of RLN after total thyroidectomy and cervical lymph node dissection for malignant tumors in the observation group and the control group(0 / 1.35%,P > 0.05)was no statistically significant.The difference of operation time(145.3±35.7 min / 157.1±37.8 min,P<0.05)between the observation group and the control group was statistically significant,and the difference of operation cost(12131.9±1037.6 Yuan / 7055.0±714.6 Yuan,P < 0.05)was statistically significant.Four patients in the observation group presented postoperative RLN injury symptoms and the corresponding emg range was 0-50%.EBSLN recognition rate between observation group and control group(62.23% / 32.76%,P<0.05)was statistically significant.The observation group identified EBSLN 28.86% to obtain emg,71.14% to elicit cricothyroid muscle tremor.Conclusion:IONM in thyroid surgery is helpful to reduce the injury rate of RLN.The changes in the amplitude of intraoperative RLN emg can be used to predict nerve function.It is helpful to improve the recognition rate of EBSLN and identify EBSLN more accurately combined with cricothyroid tremor.