术中神经监测技术在复杂甲状腺手术中的应用

Application of intraoperative neromonitoring during complex thyroid operation

目的探讨应用术中神经监测技术（intra operative neuromonitoring，IONM），以减少复杂甲状腺手术喉返神经损伤。方法吉林大学中日联谊医院甲状腺外科2009年3—7月对132例复杂甲状腺手术病人，共186支高风险喉返神经行术中神经监测。在甲状腺切除前后分别探测迷走神经及喉返神经肌电信号。甲状腺手术前后常规检查声带活动度。结果除术前声带麻痹4例，余182支喉返神经均可在甲状腺切除后测得明显肌电信号，未发生缝合切口前神经肌电信号消失，提示神经电传导功能良好。精确检出非返性喉返神经2例。结论术中喉返神经监测使喉返神经显露更加便捷，更加确切，并可验证喉返神经功能完整性。在高风险、复杂甲状腺术中应用神经监测是降低喉返神经损伤率的一种重要辅助措施。

Objective Apply the intraoperative neuromonitoring （IONM） as an adjunct to avoid recurrent laryngeal nerve （RLN） injury during complex thyroid operation. Methods From March 2009 to July 2009, 132 pations （186 nerves at risk） underwent complex thyroidectomy with the application of IONM. Vagus nerve and RLN were tested respectively before and after resection of thyroid lobe. Video recording of cord mobility was performed routinely pre- and postoperatively. Results In addition to 4 cases with preoperative vocal cord paralysis, 182 RLN after resection of thyroid lobe with a clear electromyography（EMG） and 0 % nerves experienced signal loss before closing surgical incision showed normal electrical transduction function. Accurately detect non-RLN in 2 nerves. Conclusion IONM could make RLN identification more reliabe and precise, test the functional integrity of RLN. IONM is a useful adjunct to reduce RLN palsy rate in complex thyroid operation.