非肉眼可见的喉返神经损伤的机制及其预防：术中神经监测系统在甲状腺手术中的应用

The mechanism and prevention of invisible injury of RLN in thyroid surgery： the application of intraoperative neuromonitoring system

目的探讨甲状腺手术中非肉眼可见喉返神经（RLN）损伤的机制。方法总结吉林大学中日联谊医院应用术中神经监测（IONM）系统发现的非肉眼可见RLN损伤的类型及其保护的经验。结果甲状腺手术中非肉眼可见的RLN损伤机制主要包括：Berry韧带牵拉损伤、肿物牵拉损伤、热损伤、丝线切割伤、吸引器损伤等。发现损伤后给予营养神经、对症处理，患者无永久性声带麻痹发生。结论IONM可以发现非肉眼可见的RLN损伤。通过其机制的研究，可以不断的改进手术技术，降低RLN损伤的几率。

Objective To investigate the mechanism and prevention of invisible injury of recurrent laryngeal nerve （RLN） system in thyroid surgery, with the application of intraoperative neuromonitoring （IONM） system. Methods The type of invisible RLN injury and its protection with the application of IONM system were analyzed. Results The causes of invisible RLN injury mainly included stretching of Berry ligament or the tumor, contusion, thermal injury, cutting of silk and suction injury. RLN invisible injury was recoverable through neurotrophic and symptomatic treatment. No permanent vocal cord paralysis occurred. Conclusions With the application of IONM system, some invisible type of RLN injuries can be found. The risk of RLN injury can be reduced if the surgical techniques are improved with the development of study on mechanism of IONM system.