The Meta-analysis Of The Clinical Value Of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thyroid Reoperations

Objective:To compare the difference between intraoperative recurrent laryngeal nerve monitoring and conventional exposure,and investigate the clinical value of intraoperative recurrent laryngeal nerve monitoring during thyroid reoperations.Methods:We searched databases as PUBMED?Cochrane library?CNKI ?VIP and Wan Fang with the words of thyroid Resection*?thyroid reoperation*?revision thyroidectomy? Intraoperative recurrent laryngeal nerve monitoring?intraoperative nerve monitoring to collect the randomized controlled trails(RCTs)and non-randomized controlled trails(non-RCTs)which were published from January 1992 to January 2018.The search was followed the inclusion and exclusion criteria.The data were collected and evaluated by 2 reviewers independently.The meta-analysis was performed by using Rev Man 5.3 and Stata 14.0 software.Heterogeneity across studies was tested by using the chi-square test.The combined risk estimates were computed using either fixed—effects models or random effects models with the presence of heterogeneity.We also investigated the influence of a single study on the overall risk estimate by omitting 1 study in each turn.Potential publication bias was assessed by Begg'S test to evaluate publication bias Results:A total of 8 RCTs and 8 non-RCTs involving 2336 patients were included in this study.16 studies compared the permanent rate of the recurrent laryngeal nerve(OR=0.41 95%CI=[0.23,0.72] P=0.002);15 studies compared the transient rate of the recurrent laryngeal nerve(OR=0.40 95%CI=[0.29,0.56]P<0.00001);6 studies compared the exposure time(SMD =-17.08 95%CI =[-23.36,-10.81]P<0.00001);8 studies compared the operation time(SMD =-24.03 95%CI =[-35.90,-12.16]P<0.0001);7 studies compared the amount of postoperative drainage(SMD =-9.31 95%CI =[-15.70,-2.93]P=0.004);The amount of bleeding had no statistical difference between the two groups(SMD =-10.49 95%CI=[-24.16,3.19]P= 0.13).No evidence of any individual study having excessive influence was observed.The Begg's funnel plot did not indicate evidence of publication bias.Conclusion:Compared with the conventional exposure,intraoperative recurrent laryngeal nerve monitoring can significantly reduce the rate of recurrent laryngeal nerve injury and the amount of postoperative drainage,short the exposure time and operation time.Thus,intraoperative recurrent laryngeal nerve monitoring is safe and feasible for treating thyroid diseases as the indications are under strict control.In thyroid reoperations,intraoperative recurrent laryngeal nerve monitoring should be promoted.