Balss saišu funkcionalitātes novērtēšana vairogdziedzeru operāciju perioperatīvajā periodā
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Date
2023
Authors
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Vairogdziedzera operācijas ir biežākās endokrīnās kakla operācijas un pieredzējušu ķirurgu izpildījumā ar ķirurģisku intervenci saistītais risks tiek vērtēts kā minimāls.
Balsenes atgriezeniskā nerva lokalizācija parasti ir tipiska, tāpēc nerva vizualizācija un aizsardzība operācijas laikā parasti nav kompromitēta, tomēr reizēm to ietekmē tādi faktori kā liela apjoma struma, difūza toksiska struma vai vairogdziedzeru onkoloģiska saslimšana, kas var cieši saaugt ar nervu vai cauraugt to pilnībā. Ar mērķi mazināt balsenes atgriezeniskā nerva bojājumu pēdējās desmitgadēs izmanto intraoperatīvu neiromonitorēšanu, kas pielietojama gan kā pārtraukta metode – periodiski stimulējot nervu vadīšanas loku, gan kā nepārtraukta metode – nepārtraukti stimulējot nervu operācijas lielāko daļu laika. Ir pieejami vairāki starptautiski pētījumi par intraoperatīvās neiromonitorēšanas metodes pielietojumu, kas uzrādījuši metodes augsto jutību un specifiskumu balss saišu parēzes un nerva bojājuma diagnostikai. Turklāt, metodes pielietojums ļauj saīsināt operācijas laiku un, iespējams, mazina nerva bojājuma attīstības risku.
Pētījuma mērķis ir izvērtēt intraoperatīvās neiromonitorēšanas metodes pielietošanu Latvijā - Paula Stradiņa klīniskās universitātes slimnīcā, laika periodā no 2015. līdz 2022. gadam.
Thyroidectomies are one of most commonly performed endocrine neck operations. In the hands of experienced surgeons this operation has a small risk of postoperative complications. Recurrent laryngeal nerve mostly has a typical localization, nerve visualization and preservation mostly not compromised during thyroidectomies. However, in some cases mostly depend on size of thyroid gland, or in case of presence of toxic goiter or oncology nerve may have to be compromised during thyroidectomies. To preserve laryngeal recurrent nerve for last decades surgeons, start to use intraoperative neuromonitoring method. Surgeons can choose to using interrupted – IONM (I-IONM) or continuous – IONM (C-IONM). In case of I-IONM nerve can be damaged between stimulations un surgeons will know about it only after next use of I-IONM, in case of using C-IONM nerve has stimulation most part of operation. IONM have great specificity and sensitivity to diagnose and find laryngeal recurrent nerve during operations. Additionally, IONM can decrease operation time. The aim of this investigation is to examine IONM use in Pauls Stradiņš Clinical University Hospital in period from 2015 to 2022.
Thyroidectomies are one of most commonly performed endocrine neck operations. In the hands of experienced surgeons this operation has a small risk of postoperative complications. Recurrent laryngeal nerve mostly has a typical localization, nerve visualization and preservation mostly not compromised during thyroidectomies. However, in some cases mostly depend on size of thyroid gland, or in case of presence of toxic goiter or oncology nerve may have to be compromised during thyroidectomies. To preserve laryngeal recurrent nerve for last decades surgeons, start to use intraoperative neuromonitoring method. Surgeons can choose to using interrupted – IONM (I-IONM) or continuous – IONM (C-IONM). In case of I-IONM nerve can be damaged between stimulations un surgeons will know about it only after next use of I-IONM, in case of using C-IONM nerve has stimulation most part of operation. IONM have great specificity and sensitivity to diagnose and find laryngeal recurrent nerve during operations. Additionally, IONM can decrease operation time. The aim of this investigation is to examine IONM use in Pauls Stradiņš Clinical University Hospital in period from 2015 to 2022.
Description
Ķirurgs
Surgeon
Surgeon
Keywords
Endocrine operations, thyroidectomies, intraoperative neuromonitoring method, vocal cord paresis, vairogdziedzeris, endokrīnās operācijas, intraoperatīva neiromonitorēšana, balss saišu parēze