Neuromonitorización intraoperatoria y parálisis laríngea bilateral posoperatoria en tiroidectomía total. Revisión sistemática y metanálisis

  • Guillermo Estébanez-Peláez
    Universidad de Salamanca. Facultad de Medicina. Departamento de Cirugía. Hospital Universitario de Salamanca. Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello. IBSAL. https://orcid.org/0000-0003-1122-2701 guille_estebanez[at]usal.es
  • José Luis Pardal-Refoyo
    Hospital Universitario de Salamanca. IBSAL, Instituto de Investigación Biomédica de Salamanca.Universidad de Salamanca https://orcid.org/0000-0002-7462-1606
  • Enrique González-Sánchez
    Universidad de Salamanca. Facultad de Medicina. Departamento de Cirugía. Hospital Universitario de Salamanca. Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello. IBSAL. https://orcid.org/0000-0003-4764-8907
  • Sofía Ferreira-Cendón
    Universidad de Salamanca. Facultad de Medicina. Departamento de Cirugía. Hospital Universitario de Salamanca. Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello. IBSAL

Resumen

Introducción y objetivo: La parálisis bilateral del nervio laríngeo recurrente (PBNLR) es una complicación con gran morbimortalidad en la cirugía de tiroides, aunque infrecuente. La identificación visual del nervio laríngeo recurrente (NLR) continúa siendo el patrón oro en el manejo. El objetivo es evaluar si la neuromonitorización intraoperatoria (NMIO) reduce el riesgo de PBNLR durante TT (tiroidectomía total), mediante revisión sistemática y metanálisis. Método: Revisión sistemática de artículos que incluían series de TT con y sin NMIO para la identificación del NLR, sin restricción de fecha o idioma en PubMed, BVS, Cochrane, Clinicaltrials y WoS. Se evaluó la prevalencia de PBNLR. Se realizó estudio descriptivo de las variables incluidas y metanálisis según modelo de efectos aleatorios. Resultados: Se seleccionaron 45 estudios, y se analizaron dos subgrupos: series retrospectivas (31 estudios) y series prospectivas (14 estudios); con un total de 197161 pacientes. Las series prospectivas resultaron homogéneas y con bajo sesgo de publicación, con un total de 11149 pacientes. En los estudios prospectivos, la diferencia observada del riesgo de PBNLR con y sin NMIO equivale a una reducción absoluta del riesgo (RAR) del 2.1‰ y un número necesario de técnica para realizar (NNT) de 487.15. Conclusiones: La NMIO aporta una reducción del riesgo de PBNLR.  
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Estébanez-Peláez, G., Pardal-Refoyo, J. L., González-Sánchez, E., & Ferreira-Cendón, S. (2022). Neuromonitorización intraoperatoria y parálisis laríngea bilateral posoperatoria en tiroidectomía total. Revisión sistemática y metanálisis. Revista ORL, 13(4), e28102. https://doi.org/10.14201/orl.28102

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José Luis Pardal-Refoyo

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Hospital Universitario de Salamanca. IBSAL, Instituto de Investigación Biomédica de Salamanca.Universidad de Salamanca
Universidad de Salamanca. Departamento de Cirugía. Profesor Asociado de Otorrinolaringología. IBSAL. Instituto de Investigación Biomédica de Salamanca. Grupo de Otorrinolaringología. Hospital Universitario de Salamanca.
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