ObjectiveTo discuss whether central lymph node dissection (CLND) should be performed for papillary thyroid cancer (PTC) patients. MethodsThe related domestic and foreign literatures were retrieved, the necessity of CLND and the risk of recurrent laryngeal nerve (RLN) injury in CLND were reviewed, and the application value of intraoperative nerve monitoring (IONM) in CLND were analyzed. Results① CLND can reduce the recurrence rate of PTC, improve postoperative survival rate, ease the difficulty of reoperation, and help to clarify tumor stage. ② CLND can increase the risk of RLN injury. ③ Application of INOM can decrease the risk of RLN injury. ConclusionsThe application of IONM during CLND effectively decrease the risk of RLN injury for surgeons, especially low seniority surgeons, and improve the survival quality and the prognosis. This combination will promote the implementation of routine CLND therapeutic strategy in thyroid cancer patients.
ObjectiveTo research the relevancy between the amplitudes of EMG signal of recurrent laryngeal nerve (RLN) during thyroidectemy with the movement of vocal cords after operation by applying the intraoperative neuromonitoring (IONM) and verify the proper warning criterion. MethodsFrom April 2013 to October 2013, 130 patients (214 nerves at risk) underwent complex thyroidectomy with the application of IONM. According to the degree of amplitude changing on different sites of RLN (proximal site and distal site) before closing incision, all the patients were divided into 10 groups. Every patient's vocal cords movement after operation by laryngoscopy and simulated the neural function in real time were compared. ResultsSeven patients got abnormal movement of vocal cords, the corresponding amplitudes of the EMG signal of RLN were in the range between 0 to 50%, 1 case from Group 6 (40%≤Rp/Rd<50%), 1 case from Group 8 (20%≤Rp/Rd<30%), 1 case from Group 9 (10%≤Rp/Rd<20%), 4 cases from Group 10 (0≤Rp/Rd<10%), and there's no permanent RLN palsy. ConclusionThe final amplitude of RLN decrease below 50%R1 would probably lead to vocal cords' abnormal movement, and when it decrease below 30%R1, the possibility of abnormal movement would increase; 50% decrease of EMG amplitude can be used as a warning criterion to prevent nerve function damage.