改良经环甲膜针电极法监测喉返神经功能在甲状腺手术中的应用  

Modified transcricothyroid electrode recording method for monitoring recurrent laryngeal nerve function during thyroidectomy

作　　者：李朋[1] 梁青壮 王东来[1] 韩彬[1] 易辛[1] 韦伟[1] Li Peng;Liang Qingzhuang;Wang Donglai;Han Bin;Yi Xin;Wei Wei(Department of Thyroid Surgery,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院甲状腺外科,深圳518036

出　　处：《中华内分泌外科杂志》2022年第4期431-435,共5页Chinese Journal of Endocrine Surgery

基　　金：深圳市医学重点学科建设经费资助(SZXK017);中国健康促进基金会"2020年甲状腺中青年医生研究项目"。

摘　　要：目的研究改良经环甲膜针电极法用于甲状腺术中神经监测(intraoperative neuromonitoring,IONM)的安全性、有效性和实用性。方法北京大学深圳医院甲状腺外科2017年5月至2019年5月115例拟行甲状腺手术的患者被招募入组,术中采用两个双针电极从环甲肌直部和甲状软骨下缘夹角处向外上斜行刺入环甲膜,使用标准四步法(V1-R1-R2-V2)定位,显露并评估喉返神经(recurrent laryngeal nerve,RLN)功能,手术前后电子喉镜评估声带运动情况,用t检验对比手术前后肌电信号振幅的差异。结果115例共130条RLN均记录到有效肌电信号,其中12例为巨大甲状腺肿合并气管压迫狭窄;13例为术中反复调节气管插管电极位置,但肌电信号均不满意;15例为术中意外发现复杂情况,需神经监测,但预先未使用气管插管电极;75例为志愿使用。术中3条RLN信号丢失,术后第2天复查电子喉镜提示2例声带运动正常,1例声带运动障碍,随访6个月未恢复;其他127条神经V1/R1=(1857±1718)μV/(2347±2323)μV,V2/R2=(1924±1705)μV/(2450±2345)μV,手术前后肌电信号差异无统计学意义(t=0.31和0.35,P=0.755和0.725),手术前后电子喉镜均提示声带运动正常。术中2例针电极置入点少许渗血,压迫5min后均停止,无电针折断、感染和局部血肿发生。结论改良经环甲膜针电极法用于甲状腺术中评估RLN功能被证实安全可行,具有不受气管条件影响、稳定性好、置入简单和成本低廉等优点,在甲状腺手术中可作为气管插管电极的有益补充。Objective To study the safety,validity and practicability of the modified trans-cricothyroid needle electrode method for neurmonitoring during thyroidectomy.Methods 115 patients from the Department of Thyroid Surgery in Peking University Shenzhen Hospital scheduled for thyroid surgery were recruited into the group.Two paired needle electrodes were obliquely inserted into the cricothyroid membrane from the angle between the rectus cricothyroid muscle and the inferior margin of thyroid cartilage.The function of recurrent laryngeal nerve(RLN)was localized,exposed and evaluated by standard four-step method(V1-R1-R2-V2).The vocal cord movement was evaluated by electronic laryngoscope before and after operation,and t-test was used to compare the difference of EMG signal amplitude before and after operation.Results A total of 130 RLN from 115 patients were recorded effective electromyographic(EMG)signals,including 12 cases of giant goiter with tracheal compression stenosis;13 cases had repeated adjustments of the position of tracheal intubation electrode during operation,but EMG signals were not satisfactory;15 cases were with of accidental findings during operation and requiring neurmonitoring,but tracheal intubation electrodes were not used in advance.75 cases were volunteers.The signals of 3 RLN were lost during operation.On the second day after operation,electronic laryngoscope showed that 2 cases had normal vocal cord movement and 1 case had vocal cord paralysis and no recovery for 6 months follow-up.The EMG signals of other 127 nerves were V1/R1=1857±1718μV/2347±2323μV,V2/R2=1924±1705μV/2450±2345μV.There was no significant difference in EMG signals between pre-operation and post-operation(t=0.31/0.35,P=0.755/0.725).The electronic laryngoscope showed normal vocal cord movement before and after operation.During the operation,2 patients had a little bleeding at the needle electrode insertion point,which stopped after 5 minutes of compression.No electro-acupuncture breakage,infection or local hematoma occurred

关 键 词：甲状腺手术 术中神经监测 环甲膜 针电极 喉返神经 甲状腺癌 

分 类 号：R653[医药卫生—外科学]