中国实用外科杂志

中国实用外科杂志

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甲状腺术中神经监测信号缺失原因分析

臧    宇1，田    文2，姚    京1，李    晨2   

  1. 1中国人民解放军总医院第一附属医院普通外科，北京 100048；2中国人民解放军总医院普通外科，北京 100853
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    分析甲状腺手术应用术中神经监测技术（IONM）探查喉返神经（RLN）发生信号缺失的原因并总结处理经验。方法    回顾性分析2012年10月至2015年4月中国人民解放军总医院普通外科收治的甲状腺手术中采用IONM辅助探寻保护RLN的429例病人的临床资料。分析刺激神经时产生的振幅变化，结合术后定期喉镜复查声带功能判断预后。结果    共出现34例术中信号缺失情况。其中24例为神经损伤所致，分别为牵拉伤18例、热损伤3例、钳夹伤3例，术毕前信号均有不同程度的恢复，声带最迟于术后6个月恢复正常声带功能；麻醉配合不当6例；设备自身问题3例；肿瘤压迫1例。结论    甲状腺手术结束前神经恢复程度在预测术后声带功能方面具有一定指导意义；牵拉伤发生风险最高，热损伤及钳夹伤对神经损伤更大，明确神经损伤机制可协助术者规范手术操作，尽量减少不必要的神经损伤；麻醉配合与对系统的熟练操作在系统的正常运行中具有重要作用。

关键词: 甲状腺, 术中神经监测技术, 神经损伤, 信号丢失, 损伤原因

Abstract:

Analysis of signal loss of intraoperative neuromonitoring in thyroid surgery        ZANG Yu*，TIAN Wen，YAO Jing，et al. *Department of General Surgery，the First Affiliated Hospital of PLA General Hospital，Beijing 100048，China
Corresponding author：TIAN Wen，E-mail: tianwen301_cta01@163.com
Abstract    Objective    To analyze the reason of signal loss of intraoperative neuromonitoring (IONM) for recurrent laryngeal nerve (RLN) and accumulate the experience of dealing with it. Methods    The clinical data of 429 cases of thyroid surgery with IONM to explore and protect RLN in Department of General Surgery, the General Hospital of PLA from October 2012 to April 2015 were analyzed retrospectively. The EMG change information of stimulating the nerve was reviewed and the prognosis combined with postoperative laryngoscopy were analyzed. Results    A total of 34 cases of intraoperative signal loss happened. And 24 cases were caused by nerve injury including 18 cases of traction injury，3 cases of thermal injury and 3 cases of clamp injury. The signal of nerve before completion of surgery restored of a different degree and the vocal cords returned to normal at most 6 months postoperatively. Conclusion    The degree of nerve recovery before completion of surgery has a certain guiding significance in predicting the postoperative vocal cord function.Traction injury happens more often and thermal injury and clamp injury do more harm to nerve. Clarification of nerve injury mechanism can help surgeons to regulate the surgical operation, minimizing unnecessary nerve damage. Anesthesia coordination and skilled management of the IONM system play an important role in regular running of the system.

Key words: thyroid, intraoperative neuromonitoring, nerve injury, loss of signal, injury reason