高频电刀对喉返神经热损伤的研究  

Research on thermal damage of recurrent laryngeal nerve by the high frequency electric knife

作　　者：刘溦薇[1] 邓先兆[1] 樊友本[1] 郑起[1] 康杰[1] 伍波[1] 杨治力[1] 

机构地区：[1]上海交通大学附属第六人民医院普外科,上海交通大学甲状腺疾病诊治中心,200233

出　　处：《中华内分泌外科杂志》2015年第6期487-492,共6页Chinese Journal of Endocrine Surgery

基　　金：上海市科委课题（13411982202）;上海市科委课题（14DZ1942005）

摘　　要：目的研究高频电刀在猪喉返神经（recurrent laryngeal nerve，RLN）周围使用时对神经的热损伤，探讨其安全使用范围。方法将12只实验用猪，设定电刀能量为30档（90w），作用时间为3s，作用按电刀头与神经的距离（2mm、1mm、0mm）随机分成3组。用神经监测仪测量实验前后喉肌电图的参数，进行统计分析。并取神经组织制作石蜡切片，观察损伤前后的组织学变化。结果神经检测仪显示实验组2（距离1mm）和实验组3振幅组内比较差异有统计学差异（P〈0．05）。3组振幅组间比较差异有统计学意义。组织学显示实验组3（距离为0mm）组织学有明显损伤变化。结论高频电刀在RLN周围使用的安全范围是：刀头距神经距离不小于2mm。Objective To investigate the heat effects of the high-frequency electric knife on the recurrent laryngeal nerve（RLN）in pigs and the safety margin in which electric knife can be used. Methods Totally 12 pigs for experiment were randomly divided into 3 groups by the distance between the head of the electric knife and the nerve （2 ram, 1 mm, 0 ram）. The application time of the electric knife touching RLN was set to be 3 s and the application energy of the electric knife was 90 W. The data of eleetromyogram were measured by means of nerve detector before and after operation. Statistical analysis was made based on those data. The nerve tissues were taken to make paraffin sections so that the histological change can be observed and compared before and after damage. Results The data from electromyogram by nerve detector indicated that the difference of the amplitude of group 2（ 1 ram） and group 3 （0 mm） had statistical significance（ P 〈 0. 05 ） within group. There were significant difference of the amplitude between the 3 groups. Histological study showed that the tissues of group 3 （0 mm） had obvious injury. Conclusions In thyroid surgery, the safety range of high frequency electrical knife used around RLN is： the distance from electrical knife head to nerve should be no less than 2 mm.

关 键 词：喉返神经 肌电图 热损伤 

分 类 号：R653[医药卫生—外科学]