持续性神经监测在甲状腺手术中的应用及发展

Application of the continuous nerve monitoring in thyroid surgery

喉返神经(recurrent laryngeal nerve,RLN)损伤是甲状腺手术中最常见的并发症之一,喉返神经损伤可引起声带麻痹,严重影响病人术后的生活质量。术中间断性神经监测(Intermittent Intraoperative neuromonitoring,I-IONM)能快速定位喉返神经,鉴别解剖变异,术中评估神经功能及预后,有效预防双侧喉返神经损伤的发生,减少术中喉返神经的损伤。I-IONM也具有其局限性,如仅在短暂刺激神经时才能评估RLN完整性,仅在RLN损伤发生后才能检测到等。为了克服I-IONM的局限性,术中持续性神经监测(continuous intraoperative neuromonitoring,C-IONM)应运而生。我们对C-IONM在甲状腺手术中的相关研究及进展进行简要阐述。

The recurrent laryngeal nerve（RLN） injury is one of the most common complications of thyroidectomy,it causes vocal cord paralysis and seriously affects the quality of patients＇ life post operation.Intermittent intraoperative neuromonitoring（I-IONM） is found to quickly locate the RLN during operation,indentify anatomic variation,assess the neurological function and prognosis,effectively reduce and prevent the RLN injury.Despite that,I-IONM can only detect the RLN after injury when assessing the integrity of RLN in the short period of nerve stimulation.In order to overcome the limitations of IIONM,the continuous intraoperative nerve monitoring（C-IONM） was developed.Here a brief review on the research and progress of C-IONM in thyroid surgery was presented.