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...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。展开更多
Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury.Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnost...Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury.Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies,which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve lesion.Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery.It provides significantly better information than visual inspection of the operative field,minimizing postoperative neurologic deficits due to surgical manipulation(e.g.,stretching,compression,heating from electrocauterization,constriction,or clamping of local blood vessels).These techniques exploit similar neurophysiologic principles to afford enhanced diagnostic and real-time functional data during surgery.However,an understanding of their limitations is critical for the interpretation of these data.This review discusses these techniques,including their use,advantages,and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical management-radiculopathy,mononeuropathy,and brachial plexopathy.展开更多
文摘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。
文摘目的:探讨术中神经监测(intraoperative neuromonitoring,IONM)对分化型甲状腺癌(differentiated thyroid carcinoma,DTC)患者主观语音结局的影响。方法:回顾性分析从2018年9月—2019年3月在中山大学第一附属医院接受甲状腺手术的DTC患者,分为IONM组和非IONM组,采用倾向评分匹配法(propensity score matching,PSM),比较两组患者的临床基线特征和术后主观语音结果。结果:在预防性中央区淋巴结清扫亚组中,两组患者术后1个月、6个月的声音障碍指数⁃10(voice handi⁃cap index⁃10,VHI⁃10)总分及甲状腺癌特异性生活质量(thyroid cancer specific quality of life,THYCA⁃QoL)问卷的声音领域均无统计学差异(P>0.05)。在靠近或侵犯后包膜亚组中,IONM组术后1个月、6个月的THYCA⁃QoL问卷中的声音领域评分中位数(四分位数)均为0.00(0.00,0.00),低于非IONM组的0.00(0.00,33.33),差异有统计学意义(P=0.034)。均值均为5.73,明显低于非IONM组的15.66(P=0.029)。VHI⁃10问卷两组差异无统计学意义。结论:IONM对DTC患者及预防性中央区淋巴结清扫术亚组患者的主观发声障碍没有显著影响,但可明显改善靠近后包膜高危组患者术后主观声音异常。
文摘Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury.Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies,which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve lesion.Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery.It provides significantly better information than visual inspection of the operative field,minimizing postoperative neurologic deficits due to surgical manipulation(e.g.,stretching,compression,heating from electrocauterization,constriction,or clamping of local blood vessels).These techniques exploit similar neurophysiologic principles to afford enhanced diagnostic and real-time functional data during surgery.However,an understanding of their limitations is critical for the interpretation of these data.This review discusses these techniques,including their use,advantages,and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical management-radiculopathy,mononeuropathy,and brachial plexopathy.
