Archives of otolaryngology--head & neck surgery · 2009
Intraoperative laryngeal nerve monitoring during thyroidectomy.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Donnellan Kimberly A, Pitman Karen T, Cannon C Ron, Replogle William H, Simmons Jon D
Аннотация
OBJECTIVE: To determine whether nerve integrity monitor testing during thyroidectomy predicts recurrent laryngeal nerve (RLN) function after surgery.
DESIGN: Prospective cohort outcomes study
PATIENTS: The study included 210 consecutive patients with thyroid abnormalities who underwent thyroidectomy.
METHODS: All patients were intraoperatively monitored with a nerve integrity monitoring system (Xomed NIM II; Medtronic Inc, Fridley, Minnesota), and their vocal cord function was assessed with fiberoptic laryngoscopy before and after surgery. Normal and impaired vocal cord function were compared using an independent t test with respect to postoperative vocal cord mobility, length of the RLN dissection, and the minimum stimulus needed to generate a response at the completion of surgery.
RESULTS: There was a statistically significant difference between the stimulus in milliamperes required to stimulate normal vs abnormal functioning nerves at the completion of the procedure at the cricoarytenoid joint (P = .02) and at the distal end of the RLN dissection (P < .01). A greater length of dissected nerve was associated with normal vocal cord function; however, it was not statistically significant (P = .07).
CONCLUSION: These data suggest that an RLN that responds at lower-intensity stimulation (</=0.5 mA) at the end of thyroid surgery is associated with normal vocal cord mobility.
DESIGN: Prospective cohort outcomes study
PATIENTS: The study included 210 consecutive patients with thyroid abnormalities who underwent thyroidectomy.
METHODS: All patients were intraoperatively monitored with a nerve integrity monitoring system (Xomed NIM II; Medtronic Inc, Fridley, Minnesota), and their vocal cord function was assessed with fiberoptic laryngoscopy before and after surgery. Normal and impaired vocal cord function were compared using an independent t test with respect to postoperative vocal cord mobility, length of the RLN dissection, and the minimum stimulus needed to generate a response at the completion of surgery.
RESULTS: There was a statistically significant difference between the stimulus in milliamperes required to stimulate normal vs abnormal functioning nerves at the completion of the procedure at the cricoarytenoid joint (P = .02) and at the distal end of the RLN dissection (P < .01). A greater length of dissected nerve was associated with normal vocal cord function; however, it was not statistically significant (P = .07).
CONCLUSION: These data suggest that an RLN that responds at lower-intensity stimulation (</=0.5 mA) at the end of thyroid surgery is associated with normal vocal cord mobility.