术中诱发电位监护在甲状腺手术中保护喉返神经的临床研究  

Clinical study on intraoperative evoked potentialmonitoring in the protection of recurrent laryngeal nerve in thyroidectomy

作　　者：招雄民 胡友主[2] 李永浩[1] 苏广扬 陈为桥 

机构地区：[1]广东省中山市黄圃人民医院普外科,广东中山528429 [2]暨南大学附属第一医院肝胆外科,广东广州510630

出　　处：《中国医药科学》2015年第22期124-126,204,共4页China Medicine And Pharmacy

基　　金：广东省中山市科技计划项目(20122A091)

摘　　要：目的探讨术中诱发电位监护在甲状腺手术中保护喉返神经的临床意义。方法回顾性分析我院和暨南大学附属第一医院于2012年6月-2015年6月收治的78例甲状腺手术治疗患者的病历资料,随机分为对照组和治疗组。治疗组中的患者甲状腺手术中应用肌电诱发电位监护仪引导暴露喉返神经,在喉返神经远端和近端进行电刺激,正常时切口远近端两个部位对神经刺激,产生运动反应波幅。对照组中的患者甲状腺手术中,不应用诱发电位监护仪,对比分析两组患者术后喉返神经损伤的早期症状发生率,并进行评分。结果对照组患者术后喉返神经损伤的早期临床症状的计分情况和对照组比较,明显较低,差异有统计学意义（P〈0.05）。治疗组的患者中喉返神经探查60根,对照组中的喉返神经探查有65根。治疗组喉返神经探查时间和平均手术时间和对照组比较,明显较短,差异有统计学意义（P〈0.05）。治疗组患者的喉返神经损伤率和对照组比较明显较低,差异有统计学意义（P〈0.05）。结论甲状腺手术中应用术中诱发电位监护,可以实现喉返神经的有效探查,并将手术的时间缩短,将暂时性的喉返神经损伤率降低,有助于对喉返神经损伤的原因及时发现,对术后声带功能恢复情况有效预测,将医源性喉返神经损伤发生率减少,值得临床推广和应用。Objective To explore the clinical significance of intraoperative evoked potential monitoring in the protection of the recurrent laryngeal nerve in thyroidectomy. Methods Medical history of 78 patients who were received thyroidectomy in our hospital and First Affiliated Hospital of Jinan University from June 2012 to June 2015 were retrospectively analyzed and they were randomly allocated to the control group and the treatment group.In the treatment group,myoelectricity evoked potential monitor was applied to thyroidectomy of patients in order to lead exposure of recurrent laryngeal nerve.The distal and proximal ends of recurrent laryngeal nerve were received electrical stimulation.When it was normal,distal and proximal parts of incision stimulated nerve to produce motion response amplitude.In thyroidectomy of patients in the control group,evoked potential monitor was not applied.Incidences of early symptoms of postoperative recurrent laryngeal nerve injuries of patients in two groups were compared, analyzed and scored. Results Score of early symptoms of postoperative recurrent laryngeal nerve injuries of patients in the treatment group was significantly lower than that of the control group（P〈0.05）.The difference was statistically significant.In the treatment group,there were 60 cases of recurrent laryngeal nerve exploration.But in the control group,there were 65 cases of recurrent laryngeal nerve exploration.Time for recurrent laryngeal nerve exploration and the average operation time of the treatment group were significantly shorter than those of the control group（P〈0.05）.The difference was statistically significant.Rate of recurrent laryngeal nerve injuries of the treatment group was significantly lower than that in the control group（P〈0.05）and it was statistically significant. Conclusion Application of intraoperative evoked potential monitoring in thyroidectomy can achieve effective recurrent laryngeal nerve exploration,shorten the operation time and reduce the incidence of temporary recurrent

关 键 词：术中诱发电位监护 甲状腺手术 喉返神经保护 临床价值 

分 类 号：R653[医药卫生—外科学]