喉上神经监测在腔镜辅助小切口甲状腺手术中的应用

The neuromonitoring of the external branch of the superior laryngeal nerve in Micooli＇s endoscopic thyroidectomy

目的探讨在腔镜辅助小切口甲状腺手术中，应用神经监测技术避免喉上神经外支损伤的可行性。方法2011年2-9月间36例腔镜辅助小切15I甲状腺手术患者，术中以电流刺激下环甲肌收缩活动作为阳性反应，定位喉上神经外支的走行，远离神经处理上极血管。手术前后VHI—10评分评价声音质量变化、喉镜检查观察声带活动情况。结果手术共定位56侧喉上神经外支（100％），神经与甲状腺上动脉的交叉点距离甲状腺上极〉1cm者26侧（46．4％），〈1cm者30侧（53．6％），而在甲状腺上下径〉5em患者中，则73％患者此距离〈1．0em，P=0．006，手术前后VHI-10评分差异无统计学意义（P〉0．05）。结论腔镜辅助小切口甲状腺手术中喉上神经监测可定位喉上神经外支走行，有利于预防喉上神经外支损伤。

Objective Toevaluate the intraoperative neuromonitoring of the external branch of the superior laryngeal nerve （EBSLN） during Micooli＇s endoscopic thyroidectomy in order to avoid nerve injury. Methods In this study, 36 patients with 56 nerves at risk were enrolled from February 2011 to September 2011. A positive signal is determined by observing contractions of the cricothyroid muscle to locate the EBSLN. The relationship between EBSLN and the upper pale of the thyroid or the inferior constrictor muscle was studied. The VHI-10 table was used for evaluation pre- and postoperatively. Results All 56 nerves were located successfully ,26 nerves （46. 4% ） crossed the superior thyroid artery more than 1 cm apart from the upper pole of the thyroid gland, while the other 30 nerves（53.6% ） did less than 1 em. In eases where the diameter was longer than 5 era, the nerves crossed the artery at less than 1.0 em from the upper pole in 73% cases（ P = 0. 006）. There was no significant difference between VHI-10 results before and after surgery （P 〉0. 05）. Condusions Intraoperative neuromonitoring is useful and helpful in avoiding nerve injury by locating EBSLN.