高风险甲状腺手术中喉返神经监测应用价值的探讨

Application of intraoperative neuromonitoring of recurrent laryngeal nerve during high-risk thyroid operation

目的:探讨高风险甲状腺手术中神经监测技术(IONM)临床应用价值。方法:对烟台毓璜顶医院甲状腺外科150例复杂甲状腺手术患者行术中神经监测,记录甲状腺切除前后迷走神经及喉返神经的肌电信号及寻找喉返神经的时间,并与之前未进行神经监测的200例患者做对照分析。结果:两组患者临床特征差异无统计学意义,神经监测组寻找神经时间明显缩短〔(4.27±1.83)min vs(18.15±6.24)min〕,P<0.05;监测组中15例21支RLN因牵拉、吸引等原因,肌电信号存在一过性降低,关闭切口前V2、R2与V1、R1测值相比略降低,但均可测得明显肌电信号;全组未发生缝合切口前神经肌电信号消失,术后喉镜确认暂时性喉返神经损伤5例(3.3%),对照组暂时性喉返神经损伤11例(5.5%),永久性损伤6例,差异有统计学意义,P<0.05。结论:高风险甲状腺手术实施术中喉返神经监测使喉返神经显露更加确切,时间缩短,明显减少了手术并发症。

OBJECTIVE： To investigate the efficacy of neuromonitoring recurrent laryngeal nerve during high risk thyroid operation, in order to reduce the recurrent laryngeal nerve injury. METHODS： nerve monitoring were performed in traoperative for 150 eases of patients with complex thyroid operation, recorded vagus nerve and recurrent laryngeal nerve EM（; before and after thyroidectomy and at the time of finding recurrent laryngeal nerve. The control group was 200 pa tients with out I（）NM before. RESULTS： RLN exploring mean time was （4.27±1.83） rain. while in conventional opera tion （18.15± 6.24） rain （P〈0.05）. Fifteen cases of the EMG signal decreased due to stretch, attract and other reasons. The measured values of V2 and R2 were slightly lower than that of V1 and R1 before the incision was sutured. Transient RI.N pulse was 3.3% in 5 cases% control group was 5.5% in 11 cases,and permanent injury of RI.N was in 6 cases （P〈 0.05）. CONCLUSION： In high-risk, complex thyroid surgery, the monitoring of recurrent laryngeal nerve can make the ex- posure of recurrent laryngeal nerve more precise and swiftly,hence reducing complications.