Value of exposure of recurrent laryngeal nerve during high-risk thyroid operation

Abstract

Objective To study the value of the technique of exposure of recurrent laryngeal nerve (RLN) in preventing RLN injury during high-risk thyroid operation.Methods Three hundred and twentyfive patients subject to high-risk thyroid operation were analyzed retrospectively.The patients were divided into exposure group and un-exposure group according to whether to expose the RLN during operation.RLN injury rate of the two groups was calculated according to the number of involved RLN during operation.The RLN injury rate was compared.The exposure group was divided into auxiliary exposure subgroup and routine exposure subgroup according to whether to use intraoperative neuromonitoring.The RLN injury rate and hospitalization expenses were compared between routine exposure subgroup and auxiliary exposure subgroup.Results The RLN palsy rate in exposure group and un-exposure group was 2.25％ (8/355) and 8.00％ (14/175) respectively,while the temporary RLN palsy rate was 1.97％ (7/355) and 5.14％ (9/175),and the permanent RLN palsy rate was 0.28％ (1/355) and 2.86％ (5/175) respectively.The differences were statistically significant (P ＜ 0.05).Temporary RLN palsy rate and permanent RLN palsy rate in auxiliary exposure subgroup were both lower than in routine exposure subgroup,but there was no significant difference (P ＞ 0.05).There was significant difference in hospitalization expenses between routine exposure subgroup and auxiliary exposure subgroup (P ＜ 0.05).Conclusion Exposure of RLN during high-risk thyroid operation can reduce the RLN injury rate,and application of intraoperative neuromonitoring can not decrease RLN injury rate further. Key words: Thyroid operation; Recurrent laryngeal nerve; Intraoperative neuromonitoring; Recurrent laryngeal nerve injury