颈清扫手术中对迷走神经功能的监护

目的通过颈清扫手术中迷走神经监护，探讨预防迷走神经医源性损伤的方法。方法全麻下对26例(37侧)头颈恶性肿瘤颈清扫术，采用气管插管式表面电极(endolaryngeml surface electrodes mounted on an endotracheal tube，ETT)，连续记录喉肌电活动，对可疑部位用单极刺激器行迷走神经定位，及对其神经完整性进行评估。结果迷走神经定位成功率94．6％，迷走神经功能受损时，即使外观完整，共解剖前、后电刺激反应电流阈值差异常升高。结论颈清扫手术中应用气管插管式记录电极进行迷走神经监护，能有效定位迷走神经，以降低损伤的风险。迷走神经解剖前、后电刺激反应电流阈值差异升高时要警惕其功能损伤，对此更深一步的研究尚待进行。

Vagal nerve monitoring in surgery of neck dissection

Objective Research of approaches of vagal never monitoring in surgery of neck dissection to minimize iatrogenic vagal never injury. Methods Perform neck dissection under general anesthesia for 26/37 head and neck malignant tumor,applying endolaryngeal surface electrodes mounted on an endotracheal tube,(ETT)to report laryngeal electromyography constantly.Locate vagal never in possible positions and make assess the neural integrity. Results 94.6% of the vagal never localization is successful.If the function of vagal never is injured,even with completed outlook,the threshold of stimulation current will be extremely high before and after the dissection. Conclusion Vagal never can be located effectively by applying ETT to monitor vagal never in surgery of neck dissection and reduce the risk of injury.Attention should be paid in the case that the threshold of stimulation current is extremely high before and after the dissectionas it might signal an injury of function,which deserves fruther study.