摘要
目的 应用术中神经监测技术（intraoperative neuromonitoring,IONM）在甲状腺手术中所提供的量化指标（肌电信号振幅）,对比术后喉镜检查结果,探究术中喉返神经（recurrent laryngeal nerve,RLN）的肌电信号强弱与术后声带运动的相关性,摸索IONM预警值。方法 对中日联谊医院甲状腺外科2013年4~10月期间完成的130例高RLN损伤风险甲状腺手术中的214条RLN行IONM,按术中肌电信号强弱分为10组,并与每组术后喉镜检查结果进行对比。结果 7例术后声带运动异常病例,其对应的术中RLN的肌电信号振幅下降在0~50%。无永久性RLN损伤病例。结论 手术结束前,监测的RLN肌电信号振幅下降〉50%可导致术后声带运动异常;下降〉70%,术后声带运动异常可能性较高。故振幅下降〉50%可作为术中实时监测RLN功能的“警戒值”,有助于预测术后RLN功能。
Objective To research the relevancy between the amplitudes of EMG signal of recurrent laryngeal nerve （RLN） during thyroidectemy with the movement of vocal cords after operation by applying the intraoperative neuro- monitoring （IONM） and verify the proper warning criterion. Methods From April 2013 to October 2013, 130 patients （214 nerves at risk） underwent complex thyroidectomy with the application of IONM. According to the degree of ampli- tude changing on different sites of RLN （proximal site and distal site） before closing incision, all the patients were divided into 10 groups. Every patient＇s vocal cords movement after operation by laryngoscopy and simulated the neural function in real time were compared. Results Seven patients got abnormal movement of vocal cords, the corresponding amplitudes of the EMG signal of RLN were in the range between 0 to 50%, 1 case from Group 6 （40% ≤Rp/Rd〈50%）, 1 case from Group 8 （20% ≤ Rp/Rd〈30%）, 1 case from Group 9 （10% ≤Rp/Rd〈20%）, 4 cases from Group 10 （0≤ Rp/Rd〈10%）, and there＇s no permanent RLN palsy. Conclusion The final amplitude of RLN decrease below 50%R1 would probably lead to vocal cords＇ abnormal movement, and when it decrease below 30%R1, the possibility of abnormal movement would increase; 50% decrease of EMG amplitude can be used as a warning criterion to prevent nerve function damage.
出处
《中国普外基础与临床杂志》
CAS
2015年第7期784-787,共4页
Chinese Journal of Bases and Clinics In General Surgery
基金
吉林省科技厅资助项目(项目编号:20140413063GH)~~
关键词
术中神经监测
喉返神经功能
声带运动
甲状腺手术
喉返神经损伤
Intraoperative neuromonitoring
Recurrent laryngeal nerve function
Vocal cord movement
Thyroidsurgery
Recurrent laryngeal nerve injury
