神经监测技术在继发性甲状旁腺功能亢进手术中的应用初探

Application of nerve monitoring technique in secondary hyperparathyroidism

目的探讨神经监测技术在继发性甲状旁腺功能亢进手术中的应用。方法回顾性分析手术治疗继发性甲状旁腺功能亢进病人59例,术中均应用神经监测技术。结果术后喉返神经(RLN)损伤暂时性损伤1例(1.6%,1/59),喉镜见左侧声带固定于旁正中位,术后6周双侧声带运动对称、闭合良好。术后无喉上神经及迷走神经损伤症状的病例。在神经监测技术保护下,本组共切除异常甲状旁腺236枚,术中甲状旁腺的位置对RLN损伤没有统计学意义(P>0.05)。异常甲状旁腺平均长径≥2 cm的81枚,其中1例(0.7%)出现RLN损伤;平均长径<2 cm甲状旁腺134枚,无RLN损伤,异常甲状旁腺大小对RLN损伤没有统计学意义(P>0.05)。手术时间≥1.5 h 43例,<1.5 h 16例,术后一日咽部不适47例,无咽部不适12例,手术时间长短并不是出现RLN损伤的原因,是出现术后出现咽喉部不适的因素(P<0.05)。结论对继发性甲状旁腺功能亢进病人,术中常规应用神经监测技术对降低喉神经损伤并发症,缩短手术时间有显著应用价值。

Objective To investigate the application of nerve monitoring technique in secondary hyperparathyroidism.Methods 59 patients with secondary hyperparathyroidism were retrospectively analyzed.Neurologic monitoring technique was used during operation.Results 1 case(1.6%,1/59) of recurrent laryngeal nerve(RLN) was injured temporarily.Laryngoscope showed that the left vocal cord was fixed in the paracentric median position.There were no symptoms of superior laryngeal nerve and vagus nerve injury after operation.Under the protection of nerve monitoring technique,236 abnormal parathyroid glands were resected.The location of parathyroid glands during operation had no statistical significance for RLN injury(P>0.05).There were 81 abnormal parathyroid glands with mean length ≥2 cm,in which 1 case(0.7%) had RLN injury,134 parathyroid glands with mean length 2 cm had no RLN injury,and the size of abnormal parathyroid glands had no statistical significance for RLN injury(P>0.05).Operation time ≥1.5 h 43 cases,1.5 h 16 cases,one day after operation pharyngeal discomfort 47 cases,no pharyngeal discomfort 12 cases,the length of operation is not the cause of RLN injury,it is the cause of postoperative pharyngeal discomfort(P<0.05).Conclusion For secondary hyperparathyroidism,intraoperative routine application of nerve monitoring technology can reduce the complications of laryngeal nerve injury and shorten the operation time.