甲状腺软骨电极与前喉部电极在甲状腺手术术中神经监测中提供更高且更常足够的肌电信号：一项系统评价与荟萃分析。

文献信息

中文摘要

背景： 气管插管电极常用于甲状腺和甲状旁腺手术中的术中神经监测（IONM），但导管移位和声带接触不一致可能损害肌电信号质量。甲状腺软骨电极和前喉部电极提供了一种替代记录界面，其较少依赖气管插管位置。本系统评价与荟萃分析旨在比较甲状腺软骨或前喉部记录电极与气管插管电极在甲状腺或甲状旁腺手术患者中的应用，并确定它们是否在不影响临床安全性的情况下提供更高且更常足够的肌电信号。
方法： 检索了PubMed、Web of Science、Scopus和Cochrane Library，以寻找比较甲状腺软骨或前喉部电极与气管插管电极的对照研究。采用随机效应模型，将连续结局合并为均数差（MD），将二分类结局合并为风险比（RR）。使用ROBINS-I评估偏倚风险，使用GRADE评估证据确定性。该评价已在PROSPERO注册（CRD420261454193），未获得资助。
结果： 共纳入9项研究，涉及1,206例患者和2,311个处于风险中的神经或手术侧观察。甲状腺软骨电极产生更高的V1、V2、R1和R2波幅，MD分别为571.28、591.86、604.16和847.76 µV。甲状腺软骨记录更常出现至少500 µV的足够初始V1信号，RR为1.60。S2波幅也更高，而S1波幅仍无定论。在潜伏期、总体信号丢失、暂时性声带麻痹或永久性声带麻痹方面未观察到明显差异。假阳性信号丢失倾向于甲状腺软骨电极，但未达到统计学显著性。在1,096例暴露患者中未报告电极相关并发症。然而，这些小型、非随机队列无法确定等效安全性或排除不常见并发症。
结论： 甲状腺软骨电极和前喉部电极比气管插管电极提供更强且更常足够的肌电信号，且无并发症增加的证据。其主要优势似乎在于改善记录稳定性，而非直接预防喉返神经损伤。

英文摘要

BACKGROUND: Endotracheal tube electrodes are commonly used for intraoperative neuromonitoring (IONM) during thyroid and parathyroid surgery, but tube displacement and inconsistent vocal fold contact may compromise electromyographic signal quality. Thyroid cartilage and anterior laryngeal electrodes offer an alternative recording interface that is less dependent on endotracheal tube position. This systematic review and meta-analysis aimed to compare thyroid cartilage or anterior laryngeal recording electrodes with endotracheal tube electrodes in patients undergoing thyroid or parathyroid surgery, and to determine whether they provide higher and more frequently adequate electromyographic signals without compromising clinical safety.
METHODS: PubMed, Web of Science, Scopus, and the Cochrane Library were searched for comparative studies evaluating thyroid cartilage or anterior laryngeal electrodes against endotracheal tube electrodes. Random effects models were used to pool continuous outcomes as mean differences (MD) and dichotomous outcomes as risk ratios (RRs). Risk of bias was assessed with ROBINS-I and certainty of evidence with GRADE. The review was registered in PROSPERO (CRD420261454193) and received no funding.
RESULTS: Nine studies involving 1,206 patients and 2,311 nerve at risk or surgical side observations were included. Thyroid cartilage electrodes produced higher V1, V2, R1, and R2 amplitudes, with MDs of 571.28, 591.86, 604.16, and 847.76 µV, respectively. Adequate initial V1 signals of at least 500 µV were more frequent with thyroid cartilage recording, with an RR of 1.60. S2 amplitude was also higher, while S1 amplitude remained inconclusive. No clear differences were observed in latency, overall loss of signal, transient vocal cord palsy, or permanent vocal cord palsy. False positive loss of signal favored thyroid cartilage electrodes but did not reach statistical significance. No electrode-related complications were reported among 1,096 exposed patients. These small, nonrandomized cohorts, however, cannot establish equivalent safety or exclude uncommon complications.
CONCLUSIONS: Thyroid cartilage and anterior laryngeal electrodes provide stronger and more frequently adequate electromyographic signals than endotracheal tube electrodes without evidence of increased complications. Their principal advantage appears to be improved recording stability rather than direct prevention of recurrent laryngeal nerve injury.