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目的探讨术中神经监测(IONM)技术在分化型甲状腺癌再次手术中的应用价值。方法分析济南军区总医院甲状腺乳腺外科47例分化型甲状腺癌再手术患者的临床病理资料,并在再次手术中应用IONM技术。结果再次手术后病理结果显示,再次手术前甲状腺癌残留率为45.45%,颈淋巴结转移率为82.98%。再次手术中无新的迷走神经和喉返神经损伤发生。结论初次手术术式选择不当是造成分化型甲状腺癌患者再次手术的主要原因,IONM技术可预防和减少分化型甲状腺癌再次手术中喉返神经损伤,应作为这类手术中的常规应用技术。
Objective To investigate the value of intraoperative nerve monitoring (IONM) technique in reoperation of differentiated thyroid cancer. Methods Clinical and pathological data of 47 patients with re-operation of differentiated thyroid carcinoma undergoing thyroid breast surgery at General Hospital of Jinan Military Region were analyzed. IONM technique was used in the reoperation. Results The pathological findings after reoperation showed that the residual rate of thyroid cancer before reoperation was 45.45% and the rate of cervical lymph node metastasis was 82.98%. No new vagus nerve and recurrent laryngeal nerve injury occurred in the reoperation. Conclusions The improper selection of primary surgical procedure is the main reason for reoperation in patients with differentiated thyroid carcinoma. IONM technique can prevent and reduce the recurrent laryngeal nerve injury during reoperation of differentiated thyroid cancer and should be used routinely in this type of surgery.