甲状腺手术中喉返神经保护及监测的临床应用  

Clinical Application of Recurrent Laryngeal Nerve Protection and Monitoring During Thyroidectomy

作　　者：孙辉[1] 刘晓莉[1] 张大奇[1] 付言涛[1] 付庆锋[1] 金田[1] 郑泽霖[2] 

机构地区：[1]吉林大学中日联谊医院甲状腺外科,长春130033 [2]吉林大学中日联谊医院胃肠外科,长春130033

出　　处：《中国普外基础与临床杂志》2010年第8期768-771,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨甲状腺手术中喉返神经肉眼识别及神经监测的临床意义。方法 2009年1～12月期间我院有1664例患者行甲状腺手术,其中1447例单纯行术中喉返神经肉眼识别保护,217例复杂甲状腺手术行术中喉返神经监测联合肉眼识别保护。结果应用"多位点"、"三步曲"喉返神经显露法行肉眼识别保护,喉返神经顺利识别1417例(85.16%),确认时间为(3.57±1.26)min;剩余30例(2.07%)常规识别未找到喉返神经,未使用喉返神经监测,术中仔细解剖确认时间延长至(17.02±5.48)min;暂时性喉返神经损伤23例(1.54%),术后2周内恢复15例(65.22%)。神经监测辅助联合肉眼识别下,喉返神经识别率为100%(217/217),确认时间为(2.18±0.67)min,暂时性喉返神经损伤4例(1.84%),术后2周内恢复3例(75.00%)。全部暂时性喉返神经损伤均于术后1个月内恢复,无持久性喉返神经损伤发生。结论常规肉眼识别可减少喉返神经损伤,却难以满足复杂甲状腺手术喉返神经保护需要,而神经监测联合肉眼识别可提高喉返神经识别率。Objective To investigate the clinical significance of visual identification and intraoperative neuromonitoring of recurrent laryngeal nerve （RLN） during thyroidectomy. Methods Totally 1 664 patients underwent thyroidectomy with RLN protection from January 2009 to December 2009 were included in this study,in which 1 447 cases were protected by visual identification only,and 217 complex thyroidectomy cases were protected by visual identification and intraoperative monitoring. Results By the ＂multi-sites,three steps＂ RLN exposure method,1 417 cases （85.16%） were successfully recognized and the recognition time was （3.57±1.26） min. The recognition time in the rest 30 complex cases （2.07%） without intraoperative neuromonitoring was （17.02±5.48） min. By this method,the temporary RLN injury occurred in 23 cases （1.54%） and 15 cases （65.22%） recovered within 2 weeks. In patients undewent intraoperative neuromonitoring,the recognition rate was 100% （217/217） and recognition time was （2.18±0.67） min. The temporary RLN injury occurred in 4 cases （1.84%） and 3 cases （75.00%） recovered within 2 weeks. All temporary RLN injuries recovered within 1 month and no persistent RLN injury occurred. Conclusion s Conventional visual identification can reduce the RLN injury,but not meet the needs of the RLN protection during complex thyroidectomy. The combination of visual identification and intraoperative neuromonitoring can further improve the recognition rate and shorten the recovery time of vocal cord dyskinesia.

关 键 词：喉返神经 肉眼识别 神经监测 甲状腺切除术 

分 类 号：R653[医药卫生—外科学]