喉肌电活动实时监测喉返神经在再次甲状腺手术中的应用

doi:10.3877/cma.j.issn.1674-0793.2014.01.002

中华普通外科学文献(电子版) ›› 2014, Vol. 08 ›› Issue (01) : 4 -7. doi: 10.3877/cma.j.issn.1674-0793.2014.01.002

所属专题：文献；

论著

喉肌电活动实时监测喉返神经在再次甲状腺手术中的应用

姜华¹, 李玺¹, 刘仁斌¹, 邱万寿¹, 刘瑞磊¹, 吴珏堃¹, 黄泽楠¹, 黄勇¹^,^†(

)

^1. 510630　广州，中山大学附属第三医院甲状腺乳腺外科

收稿日期:2012-06-12 出版日期:2014-02-01
通信作者: 黄勇
基金资助:
中央高校基本科研业务费专项资金(09ykpy15)

Real-time laryngeal electromyographic monitoring of recurrent laryngeal nerve during thyroid reoperation

Hua Jiang¹, Xi Li¹, Renbin Liu¹, Wanshou Qiu¹, Ruilei Liu¹, Juekun Wu¹, Zenan Huang¹, Yong Huang¹^,^†()

^1. Department of Thyroid and Breast Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

Received:2012-06-12 Published:2014-02-01
Corresponding author: Yong Huang
About author:
Corresponding author: Huang Yong, Email: Dryonghuang@189.cn

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目的

探讨实时监测技术对预防喉返神经损伤的意义及应用价值。

方法

对55例再次甲状腺手术患者在全麻手术中使用喉返神经探测仪进行实时喉返神经监测（IONM），术中分离显露喉返神经，并以神经刺激探针探测证实喉返神经在甲状腺后段行程及功能状态以保护其免受损伤，评估患者术后喉返神经损伤和声带功能恢复情况。

结果

共探测喉返神经107条，均成功显露。4例术前已证实有单侧声带麻痹的患者，术中探查该侧喉返神经证实3例被离断，另有1例被结扎，经松解后喉返神经肌电信号恢复，术后声带功能恢复。2例（3.64%）完整显露喉返神经的病例，手术结束前肌电信号消失，术后出现暂时性声带麻痹，均于2个月内恢复。

结论

使用喉返神经探测仪利于显露和保护喉返神经，有助于发现导致喉返神经损伤的原因并能较好地预测术后声带功能恢复的情况，减少医源性喉返神经损伤发生率，值得在再次甲状腺手术中推广。

关键词: 喉返神经, 甲状腺, 再手术, 实时监测

Objective

To assess the usage and value of monitoring the recurrent laryngeal nerve(RLN) during thyroid surgery by real-time laryngeal electromyography.

Methods

Fifty-five patients were under general anesthesia and thyroid reoperation. NIM-Response^TM electromyographic (EMG) monitor system was used for assistance of dissection, exposure and protection of the RLN during the surgical procedures.

Results

There were 107 RLNs exposed during the surgeries in all 55 patients. The unilateral RLN injured in 4 patients were also explored, among them 3 injuries were caused by transection, and 1 by ligation, which was detected precisely and released, the EMG recovered intraoperation and the vocal cord function recovered postoperation. The EMG of two successfully revealed RLN disappeared during surgical procedures, temporary vocal cord paralysis occurred and recovered in two months, the temporary palsy rate was 3.64% (2/55).

Conclusions

EMG monitor system is sensitive and accurate for explosing and preserving the RLN during thyroid reoperation. It is valuable for detecting the injury causes of RLN and predicting the postoperative function of vocal cord. This system deserves general utilization for thyroid surgery, especially for reoperation.

Key words: Recurrent laryngeal nerve, Thyroid, Reoperation, Real-time monitoring

图1 喉返神经监测的设备及操作过程　A:加强型气管插管式表面电极带导线插管；B:将刺激电极负极及参考电极分别插入患者左上臂外侧皮下并进行导线连接；C:解剖分离喉返神经,用探测笔刺激喉返神经；D:记录肌电波波幅

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