术中喉返神经监测在复杂甲状腺手术中的应用

目的探讨术中喉返神经监测在复杂甲状腺开放手术中的意义。方法对220例复杂甲状腺开放手术行术中喉返神经监测，术中用两针刺记录电极斜行刺入环甲肌，同时用刺激电极刺激气管食管沟，如发现喉返神经，即发出“嘟、嘟”长音，在监视器上显示肌电波形后小心分离，完全解剖出喉返神经至入喉处。结果207例（278条）清晰显示引出肌电波形；13例未引出肌电波形，其中9例系机器和麻醉因素造成假阴性，4例肿瘤浸润环甲肌无法有效插入记录电极。无永久性喉返神经损伤，暂时性神经损伤2例，术后1个月内恢复。结论甲状腺复杂术中应用喉返神经监测可有效保护喉返神经。

Intraoperative neuromonitoring in thyroid gland surgery

Objective To summarize the experience of intraoperative neuromonitoring （IONM） system for monitoring and protection of recurrent laryngeal nerve （RLN） during thyroid surgery. Methods A total of 220 cases were enrolled in this study （53 males and 167 females） , with the median age of 38.2 years old. There were 85 cases of thyroid cancer, 19 cases of thyroid benign tumor, 90 cases of thyroid goiter, 3 cases of Hashimoto＇s diseases, and 23 cases of hyperthyroidism. 113 cases had tumors larger than 5 cm in diameter. During the procedure, 2 recording needle electrodes were put in ericothyroid muscle and 1 stimulator electrode was explored in tracheoasophageal groove. If any RLN was right there or nearby, doctors can see the electromyogram and hear the toothonk. With careful dissection, RLN can be found out till exploring into the larynx site. Results Electromyogram showed in 207 cases （278 nerves）, and it didn＇t show in 13 cases, among whom 9 cases were false-negative because of system or annesthesia problems, 4 cases didn＇t manage to have needle electrodes put in properly due to cricothyroid muscle being invaded. No permanent RLN paralysis occoured. Transient nerve paralysis occurred in 2 cases, who recovered in 1 month after operation. Conclusion IONM system is an effective way to avoid damage to RLN in thyroidectomy.