术中神经监测在甲状腺再次手术中应用.docVIP

术中神经监测在甲状腺再次手术中的应用 吕斌 陈波 李鲁传 曾庆东 作者单位：山东大学齐鲁医院普外科，济南，250012。 通讯作者：曾庆东，E-mail: HYPERLINK mailto:zengqingdong@ zengqingdong@ 【摘要】目的 探讨在甲状腺再次手术中应用术中神经监测（intra operative neuromonitoring， IONM）的方法及使用价值。方法 对32例甲状腺再次手术患者，共50支喉返神经进行术中神经监测。在甲状腺切除前后分别记录迷走神经及喉返神经的肌电信号。结果 1支喉返神经在关闭切口前发生肌电信号消失，术后出现暂时性声带麻痹，术后第10周声带运动恢复正常。其余49支喉返神经，甲状腺切除前后迷走神经及喉返神经的肌电信号强度无统计学差异。结论 IONM在甲状腺再次手术中的应用可帮助我们更好地辨认显露喉返神经，并可验证喉返神经的功能，是一种重要的辅助措施。 【关键词】 术中神经监测；喉返神经；甲状腺再次手术 Application of Intraperative Neuromonitoring During Revision Thyroid Surgery Lv bin, Chen bo, Li luchuan, et al. Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, PR China. Corresponding author: Zeng qingdong, E-mail: HYPERLINK mailto:zengqingdong@ zengqingdong@ Abstract Objective To evaluate the application of intraoperative recurrent laryngeal nerve (RLN) monitoring during revision thyroid surgery. Methods 32 patients (50 RLN at risk) who underwent revision thyroid operations with intraoperative neuromonitoring were included. Electromyographic (EMG) signals were obtained from vagus and RLN before and after resection of thyroid lobe. Results 1 nerves experienced loss of EMG signal before closing the incision and developed temporary palsy, follow-up showed that this nerve regained normal cord function within 10 weeks. Among other nerves with normal vocal function, the mean amplitudes of EMG signals obtained from vagus and RLN after resection of thyroid lobe were not significantly different from those obtained before resection of thyroid lobe. Conclusion Intraoperative neuromonitoring could help us to identify RLN and confirm the functional integrity of RLN, and it is very useful during revision thyroid surgery. Keywords intraoperative neuromonitoring, recurrent laryngeal nerve, revision thyroid surgery. 喉返神经（recurrent laryngeal nerve, RLN）的医源性损伤是甲状腺手术的严重并发症之一，损伤一侧喉返神经可引起患者声音嘶哑，如损伤两侧喉返神经则有引起呼吸困难，甚至窒息的可能。初次甲状腺手术发生暂时性喉返神经损伤的几率为5~6%，永久性喉返神经损伤的几率为0.4~4%[1]，而再次手术其发生几率大大增加。Hemmerling报道[2]，甲状腺二次手