甲状腺甲状旁腺术中神经功能实时监测

Real time monitoring of nerve function in thyroid gland/parathyroid glands during operation

目的探讨应用自主研发改良的术中神经功能实时监测方法对术中喉返神经功能进行实时监测的临床效果与意义。方法对我院与中山大学孙逸仙纪念医院、昆明医科大学附一院、河南省肿瘤医院共计761例甲状腺/甲状旁腺患者应用人体术中神经多功能检测报警系统进行术中神经功能实时监测。结果术中双侧475例(950条),单侧286例(286条),共1236条喉返神经功能监测顺利,术后行喉镜检查有12例出现声带麻痹,3个月内恢复正常,喉返神经损伤永久性损伤为2例。喉返神经探查时间为(3.1±1.1)分钟,术中喉返神经损伤识别率、暂时性损伤率及永久性损伤率分别为100%、1.58%(12/761)和0.26%(2/761)。结论术中神经功能实时监测技术在甲状腺手术中的应用,降低手术难度,减轻术者与患者的心理压力,缩短喉返神经探查时间,能及时有效的监测与保护喉返神经,有广泛推广的应用前景。

OBJECTIVE To explore the clinical effect and significance of real-time monitoring of the function of recurrent laryngeal nerve during the operation.METHODS A multifunctional alarm system for human intraoperative nerve detection was used in total of 761 cases in our hospital, Sun Yat-sen Memorial Hospital of Sun Yatsen University, the First Affiliated Hospital of Kunming Medical Universitythe and Henan Cancer Hospital, Henan for real time monitoring of nerve function. RESULTS A total of 1236 recurrent laryngeal nerves（475 cases were bilatera and 286 cases were unilateral） were monitored.Twelve cases were found with vocal cord paralysis after operation and recovered within 3 months. Two cases with permanent recurrent laryngeal nerve injury. The detection time of recurrent laryngeal nerve, the recognition rate of recurrent laryngeal nerve injury, temporary injury rate and permanent injury rate were（3.1±1.1）min, 100%, 1.58%（12/761） and 0.26%（2/761） respectively. CONCLUSION The application of real-time monitoring technique of nerve function in thyroid surgery decrease the difficulty of operation, psychological pressure of the surgeons and patients and the exploration time of recurrent laryngeal nerve,which can monitor and protect the recurrent laryngeal nerve timely and effectively. This technique has extensive application prospect.