CAJ | 학술논문

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.
목적 탐토술중후반신경감측재복잡갑상선개방수술중적의의.방법 대220례복잡갑상선개방수술행술중후반신경감측,술중용량침자기록전겁사행자입배갑기,동시용자격전겁자격기관식관구,여발현후반신경,즉발출“도、도”장음,재감시기상현시기전파형후소심분리,완전해부출후반신경지입후처.결과 207례(278조)청석현시인출기전파형；13례미인출기전파형,기중9례계궤기화마취인소조성가음성,4례종류침윤배갑기무법유효삽입기록전겁.무영구성후반신경손상,잠시성신경손상2례,술후1개월내회복.결론 갑상선복잡술중응용후반신경감측가유효보호후반신경.
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 cricothyroid muscle and 1 stimulator electrode was explored in tracheoasophageal groove.If any RLN was fight 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.