神经电生理监测技术在甲状腺及甲状旁腺手术中的应用进展  

Advances in Intraoperative Neuromonitoring During Thyroid or Parathyroid Surgery

作　　者：邓巧莲[1,2] 朱精强[1] 

机构地区：[1]四川大学华西医院甲状腺疾病诊治中心,四川成都610041 [2]自贡市第一人民医院甲状腺乳腺外科,四川自贡643000

出　　处：《中国普外基础与临床杂志》2015年第7期811-815,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的介绍神经电生理监测技术在甲状腺及甲状旁腺手术中应用的研究进展。方法收集国内外近年来有关神经电生理监测应用于甲状腺及甲状旁腺手术的研究文献,并作综述。结果甲状腺手术中神经监测的形式从有创改良为无创性气管插管表面电极形式;监测方法从无统一标准发展为标准化程序,从间断性监测发展到连续性监测;从单纯监测喉返神经发展到还可监测喉上神经,可以十分容易地判断喉不返神经、损伤点及损伤程度,还可推测可能的损伤机理及防止不可逆的神经损伤。结论神经电生理监测应用于甲状腺及甲状旁腺手术,尤其是复杂的或二次手术,可以降低喉返神经损伤的风险,并且对术后喉返神经功能提供了循证学的预测依据,指导手术决策,以避免发生严重的术后并发症。Objective To introduce the advances of intraoperative neuromonitoring （IONM） during thyroid or parathyroid surgery. Methods The literatures about IONM during thyroid or parathyroid surgery in recent years at home and abroad were collected and reviewed. Results IONM is improved from invasive to noninvasive： endotracheal intubation with electrode on its surface. Standardized procedures of IONM is developed. Intermittent monitoring is replaced by continuous monitoring. The monitoring of external branch of superior laryngeal nerve is also a supplement to laryngeal recurrent nerve. With the aid of IONM, non-recurrent laryngeal nerve could be identified easily, also injury spot, and damage degree. We could speculate probable damage mechanisms and prevent irreversible nerve damage through IONM. Conclusions IONM could be an effective technique to reduce the risk of recurrent laryngeal nerve injury during thyroid or parathyroid surgery, especially in complex surgery and reoperations, which could predict the postoperative function of laryngeal recurrent nerve, and help to avoid severe postoperative complications.

关 键 词：术中神经监测 甲状腺 甲状旁腺 

分 类 号：R653[医药卫生—外科学]