改良经环甲膜肌电信号记录法用于全乳晕入路腔镜甲状腺手术

Modified transcricothyroid electrode recording method for neuromonitoring during endoscopic thyroidectomy via total areola approach

目的验证改良经环甲膜肌电信号记录法用于全乳晕腔镜甲状腺手术术中神经监测安全性和可行性。方法行全乳晕腔镜单侧甲状腺手术病人50例。在使用气管插管表面电极的同时,一个双针电极经10 mm Trocar观察孔置入手术腔隙,在腔镜镜头引导下将针电极插入环甲肌直部和甲状软骨之间。在术中使用标准四步法(V1-R1-R2-V2)定位、显露并评估喉返神经功能。结果50例病人均成功实施了全乳晕腔镜单侧甲状腺手术。术中共监测了50条喉返神经,经环甲膜针电极和气管插管表面电极均成功记录到有效的肌电信号。经环甲膜针电极的肌电信号振幅大于气管插管表面电极[V1/R1=(2179.3±1252.3/2304.8±1644.0)μV vs(937.2±612.8/1088.9±613.5)μV]。术中未发生肌电信号丢失事件,肿瘤切除前后肌电信号无明显变化,手术前后电子喉镜均提示声带运动正常。结论改良经环甲膜肌电信号记录法用于全乳晕腔镜甲状腺手术中神经监测安全可行;安装方便,肌电信号强,不受气管插管位置影响,对腔镜手术操作影响小。

Objective To verify the safety and feasibility of modified transcricothyroid electromyography for intraoperative nerve monitoring in total areolar endoscopic thyroid surgery.Methods 50 patients who were going to undergo total areola endoscopic thyroidectomy were recruited.At the same time of using the surface electrode of endotracheal intubation,a paired needle electrode was inserted between the cricothyroid muscle and thyroid cartilage under the guidance of the endoscopy.The standard four-step method(V1-R1-R2-V2)was used to locate,expose and evaluate the function of the recurrent laryngeal nerve during the operation,and the electronic fiber laryngoscope was used to evaluate the vocal cord movement before and after the operation.Results A total of 50 recurrent laryngeal nerves were monitored during the operation,and effective electromyography(EMG)signals were successfully recorded through cricothyroid needle electrode and endotracheal intubation surface electrode.The EMG signal amplitude of the cricothyroid needle electrode is larger than that of the endotracheal intubation surface electrode[V1/R1=(2179.3±1252.3/2304.8±1644.0)μV vs(937.2±612.8/1088.9±613.5)μV].There was no loss of EMG signal during the operation,and there was no obvious change of EMG signal before and after tumor resection.The electronic fiber laryngoscope indicated normal vocal cord movement before and after the operation.Conclusion Improved transcricothyroid EMG signal recording method is safe and feasible for neuromonitoring in total areola endoscopic thyroidectomy.It has the advantages of convenient installation,strong EMG signal,no influence of tracheal intubation position and little influence on endoscopic operation.