腮腺手术中面神经实时监测的应用与意义

目的 评价面神经术中实时监测在腮腺手术中的作用、监测方法及应用前景.方法 2000至2008年65例腮腺手术(实验组)中应用神经监护仪(NIM-pulse型)行面神经功能监测,面神经顺行解剖法(主干法)18例,逆行解剖法(分支法)35例,顺行逆行结合法12例.全部病例采用静吸复合全身麻醉,记录手术时间和电刺激最小电流阈值.对照组为44例未行面神经监测的腮腺手术病例,全部为逆行解剖法.结果 实验组中4例术后发生轻度暂时性面神经麻痹(6.1%),无永久性面瘫;平均手术时间为1.8 h;平均最小电刺激阈值为0.15 mA,适宜刺激电流范围为0.2-1.0 mA.对照组术后暂时性面神经麻痹9例(20.5%),永久性面瘫2例(4.5%);平均手术时间为3.0 h.结论 腮腺手术中面神经实时监测可以帮助术者迅速定位识别神经并缩短手术时间,为术后面神经功能评估提供客观指标,提高神经保全率.

Intraoperative facial nerve monitoring in parotid gland surgery

Objective To revaluate the value and the methods of intraoperative facial nerve monitoring in parotid gland surgery. Methods Sixty-five cases received intraoperative facial nerve monitoring in parotidectomy (test group) since 2000-2008. The facial nerve was identified through centraltrunk method (n=18), branch method (n=35) and mixed method (n=12). Most patients accepted general anesthesia by incubation. The operating duration and minimum electronic stimulation threshold values of EMG in evoked facial muscle were recorded. Facial nerve was identified though branch method (n=44) and no intraoperative facial nerve monitoring was performed in parotidectomy (control group). Results There were four cases (6.1%) of mild temporary paralysis and no permanent post-operative paralysis of facial nerve in the test group. The average operating duration was 1.8 hour. The minimum reactive electronic stimulation threshold of EMG in evoked facial muscle was 0.08mA. The range of suitable electronic stimulation threshold of EMG was from 0.2mA to 1.0mA. While there were nine cases (20.5%) of mild temporary paralysis and two cases (4.5%) of permanent post-operative paralysis of facial nerve in the control group and the average operating duration was 3.0 hours. Conclusion Intraoperative facial nerve monitoring (IFNM) in parotidectomy can assist a surgeon to confirm and identify the facial nerve and exercise precautions so as to shorten operating duration and prevent potential surgical complications.