甲状腺手術における術中反回神経モニタリングシステムの有用性の検討

Abstract

Introduction : Recurrent laryngeal nerve (RLN) palsy is one of the most serious complications in thyroid surgery. Intraoperative identification and preservation of the RLN is essential during thyroid surgery. The latest methods of intraoperative monitoring involve the use of special disposable endotracheal tubes with integrated electrodes. In Japan, no studies were available that evaluated whether the introduction of intraoperative neuromonitoring reduced the rate of RLN palsy. We reported our experience in using this monitoring system.Methods : Between October 2006 and June 2007, thyroid tumor surgery with intraoperative identification with and without additional intraoperative RLN neuromonitoring was performed on 53 patients. These cases were examined for postoperative nerve palsy, intraoperative blood loss and operation time.Result : The rates of RLN palsy based on nerves with or without intraoperative neuromonitoring at risk were 7.7% and 3.7% respectively. All nerve palsies were transient. These rates were not significantly different. Intraoperative blood loss and operation time were not significantly different in both group.Conclusions : The incidence of RLN palsy was not decrease by the use of intraoperative neuromonitoring; however, this monitoring system is not injurious to patients. Intraoperative neuromonitoring is recommended for high risk surgeries such as re-operation, the presence of a huge tumor, and low-volume surgeons.