喉前皮下针电极用于小切口甲状旁腺手术术中神经监测临床研究

Subcutaneous needle electrode of anterior laryngeal for neuromonitoring during minimally invasive parathyroidectomy

目的探讨喉前皮下针电极记录肌电信号用于小切口甲状旁腺手术中神经监测的安全性和可行性。方法选择2018年5月至2019年10月北京大学深圳医院甲状腺乳腺外科收治的20例行小切口甲状旁腺手术的原发性甲状旁腺功能亢进病人。术中分别采用喉前皮下针电极和气管插管表面电极监测喉返神经功能。结果20例病人均顺利完成手术。气管插管表面电极记录肌电信号为:V1=(976.5±452.3)μV,R1=(1161.2±548.3)μV,V2=(966.6±416.2)μV,R2=(1168.2±528.5)μV;喉前皮下电极记录肌电信号为:V1=(548.7±216.1)μV,R1=(677.8±263.4)μV,V2=(545.7±204.4)μV,R2=(679.8±270.4)μV,肿瘤切除前后肌电信号振幅差异无统计学意义(P>0.05)。在针电极置入过程中,未发生皮下血肿和电针折断,无医务人员被针电极刺伤事件,术后无喉部皮肤感染和瘢痕形成。喉前皮下针电极记录的肌电信号强度约为气管插管表面电极的50%,与性别、年龄、病变部位和血钙水平均无关。结论喉前皮下针电极用于小切口甲状旁腺手术中神经监测安全可行,具有稳定性好、安装方便和成本低廉的特点,但肌电信号强度仅约为气管插管表面电极的50%。

Objective To investigate the safety and feasibility of anterior laryngeal subcutaneous needle electrode(LSNE)for intraoperative neuromonitoring(IONM)during minimally invasive parathyroidectomy(MIP)with primary hyperparathyroidism(PHPT).Methods From May 2018 to October 2019,twenty patients with PHPT who underwent MIP were selected in the Department of thyroid and breast surgery of Peking University Shenzhen Hospital.The function of recurrent laryngeal nerve(RLN)was monitored by LSNE and tracheal intubation surface electrode.Results completed the operation successfully.The electromyography(EMG)signals recorded by the surface electrode of endotracheal intubation were:V1=(976.5±452.3)μV,R1=(1161.2±548.3)μV,V2=(966.6±416.2)μV,R2=(1168.2±528.5)μV.The EMG signals recorded by laryngeal subcutaneous electrode were:V1=(548.7±216.1)μV,R1=(677.8±263.4)μV,V2=(545.7±204.4)μV,R2=(679.8±270.4)μV.There was no significant difference in EMG signals before and after tumor resection.In the process of needle electrode implantation,there was no pre laryngeal subcutaneous hematoma and electroacupuncture fracture,no laryngeal skin infection and scar formation,and no medical staff were stabbed by needle electrode.The EMG signals recorded by anterior LSNE were approximately 50% of that by the surface electrode of the endotracheal intubation and were not related to sex,age,tumor location,and blood calcium level.Conclusion The anterior LSNE recording method is safe and feasible for IONM during MIP.It has the characteristics of good stability,convenient installation and low cost,but the amplitude of EMG signals was approximately 50%of the tracheal intubation surface electrode.