CAJ | 학술논문

目的探讨实时监测技术对预防喉返神经损伤的意义及应用价值。方法对55例再次甲状腺手术患者在全麻手术中使用喉返神经探测仪进行实时喉返神经监测（IONM），术中分离显露喉返神经，并以神经刺激探针探测证实喉返神经在甲状腺后段行程及功能状态以保护其免受损伤，评估患者术后喉返神经损伤和声带功能恢复情况。结果共探测喉返神经107条，均成功显露。4例术前已证实有单侧声带麻痹的患者，术中探查该侧喉返神经证实3例被离断，另有1例被结扎，经松解后喉返神经肌电信号恢复，术后声带功能恢复。2例（3.64%）完整显露喉返神经的病例，手术结束前肌电信号消失，术后出现暂时性声带麻痹，均于2个月内恢复。结论使用喉返神经探测仪利于显露和保护喉返神经，有助于发现导致喉返神经损伤的原因并能较好地预测术后声带功能恢复的情况，减少医源性喉返神经损伤发生率，值得在再次甲状腺手术中推广。
목적탐토실시감측기술대예방후반신경손상적의의급응용개치。방법대55례재차갑상선수술환자재전마수술중사용후반신경탐측의진행실시후반신경감측（IONM），술중분리현로후반신경，병이신경자격탐침탐측증실후반신경재갑상선후단행정급공능상태이보호기면수손상，평고환자술후후반신경손상화성대공능회복정황。결과공탐측후반신경107조，균성공현로。4례술전이증실유단측성대마비적환자，술중탐사해측후반신경증실3례피리단，령유1례피결찰，경송해후후반신경기전신호회복，술후성대공능회복。2례（3.64%）완정현로후반신경적병례，수술결속전기전신호소실，술후출현잠시성성대마비，균우2개월내회복。결론사용후반신경탐측의리우현로화보호후반신경，유조우발현도치후반신경손상적원인병능교호지예측술후성대공능회복적정황，감소의원성후반신경손상발생솔，치득재재차갑상선수술중추엄。
Objective To assess the usage and value of monitoring the recurrent laryngeal nerve(RLN) during thyroid surgery by real-time laryngeal electromyography. Methods Fifty-five patients were under general anesthesia and thyroid reoperation. NIM-ResponseTM electromyographic (EMG) monitor system was used for assistance of dissection, exposure and protection of the RLN during the surgical procedures. Results There were 107 RLNs exposed during the surgeries in all 55 patients. The unilateral RLN injured in 4 patients were also explored, among them 3 injuries were caused by transection, and 1 by ligation, which was detected precisely and released, the EMG recovered intraoperation and the vocal cord function recovered postoperation. The EMG of two successfully revealed RLN disappeared during surgical procedures, temporary vocal cord paralysis occurred and recovered in two months, the temporary palsy rate was 3.64%(2/55). Conclusions EMG monitor system is sensitive and accurate for explosing and preserving the RLN during thyroid reoperation. It is valuable for detecting the injury causes of RLN and predicting the postoperative function of vocal cord. This system deserves general utilization for thyroid surgery, especially for reoperation.