ABSTRACT
Objective To investigate the clinical effect of intra-operative recurrent laryngeal nerve(RLN) monitoring in subtotal thyroidectomy of patients with nodular goiter.Methods The clinical data of 83 patients with nodular goiter admitted from Jan.2014 to Oct.2017 were analyzed.They were divided into non-monitoring group(38 cases) and the monitoring group (45 cases).9 patients had masses with a maximum diameter larger than 7 cm and 29 patients had masses with maximum diameter between 4 and 7 cm in the non-monitoring group.Among the 38 masses compressing trachea,one case also had esophagus compression.In the monitoring group,the maximal diameter of mass was larger than 7 cm in 15 cases and 4 to 7 cm in 30 cases.All the 32 cases had trachea compression and 2 cases had esophagus compression.All patients underwent routine laryngoscopy preoperatively,suggesting no RLN paralyses.Both groups underwent subtotal thyroidectomy under general anesthesia.Results In non-monitoring group,there were 18 cases with RLN exposed.Five patients had hoarseness after operation,and laryngoscopy showed weakened ipsilateral vocal cord.In the monitoring group,all patients successfully received the surgery and signals V1 were obtained during nerve monitoring.A total of 21 RLN were exposed intraoperatively.Signals V2 were obtained postoperatively,and they showed no significant reduction as compared to signals V1 and no hoarseness occurred.Incidence of RLN injury in monitoring group was significantly lower than that in non-monitoring group (P＜0.05,P=0.04).The rate of RLN injury in the non-monitoring group was higher than that in the monitoring group.Conclusion In the surgery for nodular goiter,intra-operative RLN monitoring can be applied to determine neural function and can effectively reduce the risk of RLN injury.