| ObjectiveStudy the protective effect of external branch of superior laryngeal nerve monitoring technique on the vocal function of patients through the retrospective investigation of postoperative vocal function in patients undergoing thyroid surgery.Analyze the value of application of the external branch of superior laryngeal nerve monitoring technique in thyroid surgery,especially in surgery for the tumor in upper pole.Use the neurological monitoring technique to ensure the identification and function of the external branch of superior laryngeal nerve in thyroid surgery.Methods1?From November 2016 to June 2017,104 patients who underwent thyroid surgery in general surgery department of PLA general hospital due to "thyroid papillary cancer"without superior laryngeal nerve monitoring and protection were collected as the control group,and 139 patients who underwent thyroid surgery and superior laryngeal nerve monitoring and protection in this department from June 2017 to March 2018 were collected as the IONM group.Patients in the two groups were followed up 1 week after surgery and 6 months after surgery to investigate the symptoms of postoperative complaints,and the patients' vocal function was evaluated in the form of VHI-10 questionnaire.To analyze and compare the protective effect of nerve monitoring technique on superior laryngeal nerve.Factors such as gender,age,upper and lower thyroid diameter,tumor size,tumor location(distance from the top pole),and surgical method were extracted from all cases in the control group and the observation group to compare the relationship between tumor location factors and IONM's protective effect on EBSLN in patients in the two groups.2?From June 2017 to March 2018,139 cases of primary surgical treatment for thyroid papillary carcinoma in the general surgery department of the PLA general hospital and the use of intraoperative neuromonitoring technology were collected,and 218 cases of the upper pole(EBSLN218)were processed accumulatively.The recognition rate of EBSLN under direct vision and assisted by intraoperative nerve monitoring(IONM)technology was statistically analyzed,and the promotion effect of IONM on the recognition efficiency of EBSLN in the operation of thyroid upper polar tumors was analyzed.Result1?Factors such as gender,age,upper and lower thyroid diameter,tumor size,tumor location(distance from the top pole)and surgical method were extracted from all cases in the control group and the observation group,and there is no significant difference.Among the 139 patients in the monitoring group,5 cases(3.6%)presented symptoms of low voice,vocal changes,and vocal fatigue at 1 week after the operation,and none of them complained again 6 months after the operation.Among the 104 patients in the control group,11(10.8%)developed low voice at 1 week after surgery,and 1 patient complained of dysphonia 6 months after surgery.The vhi-10 scores of the monitoring group 1 week after surgery and 6 months after surgery were significantly lower than those of the control group(in line with the normal distribution,P<0.05).The postoperative injury rate of patients in the monitoring group was significantly lower than that of the control group(x2=4.901,P=0.027),and the vhi-10 score at 1 week after surgery and 6 months after surgery was significantly lower than that of the control group.2?In the 139 patients,there were 218 upper poles(218 EBSLN)treated intraoperatively,of which 145 were recognized visually(126 confirmed by IONM(57.8%)),and 203 were identified by IONM(93.1%)(?2=59.345,P=0.00).The percentage of EBLSN located in the upper pole accurately identified by the naked eye is 20/46(43.5%)while by the IONM was 43/46(93.4%).The percentage of EBSLN at the other position was accurately identified visually is 106/172(61.6%),and by IONM is 160/172(93.0%).The number of visually identified cases in different locations showed significantly differences from the chi-square test(?2=4.901,P=0.027),and there was no difference from the IONM identification chi-square test(?2=0.012,P=0.914).ConclusionsIntraoperative nerve monitoring technology of thyroid is of great significance for the functional protection of the superior laryngeal nerve external branch.Intraoperative monitoring of the superior laryngeal nerve external branch can effectively reduce the occurrence of postoperative muffled voices in patients and improve the postoperative quality of life.Compared with visual identification,intraoperative neuro-monitoring technology can significantly improve the ratio of intraoperative EBSLN recognition and ensure the safety of surgery.It is more difficult for EBSLN to be recognized by naked eyes in the operation of the upper thyroid tumor than the operation in other locations.IONM can provide a more reliable basis for neuroprotection and reduce the surgical risk. |
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