CAJ | 학술논문

目的探讨在甲状腺手术中应用神经监测技术确定喉上神经外支解剖分型的临床意义.方法 2011年3-10月,在70例甲状腺手术患者术中以喉上神经外支受电流刺激后可产生环甲肌收缩活动作为阳性反应定位喉上神经外支的走行并判明其与甲状腺上极、咽下缩肌的关系.结果手术共定位108条喉上神经外支(99.1％),解剖显露42条(38.9％),神经与甲状腺上动脉的交叉点距离甲状腺上极＞1 cm者55条(50.9％),＜1 cm者53条.＜0.5 cm或者位于腺体背面者29条(26.9％),为喉上神经外支高风险分型,＞0.5 cm＜1 cm者24条(22.2％),甲状腺上下径＞5 cm者中＜0.5 cm或者位于腺体背面比例显著增加.手术前后均行喉镜检查,一例术后出现发音低沉等喉上神经外支损伤表现.结论甲状腺手术中神经监测技术可以定位喉上神经外支的走行及其变异并指导手术者规避神经损伤风险.
목적 탐토재갑상선수술중응용신경감측기술학정후상신경외지해부분형적림상의의.방법 2011년3-10월,재70례갑상선수술환자술중이후상신경외지수전류자격후가산생배갑기수축활동작위양성반응정위후상신경외지적주행병판명기여갑상선상겁、인하축기적관계.결과 수술공정위108조후상신경외지(99.1％),해부현로42조(38.9％),신경여갑상선상동맥적교차점거리갑상선상겁＞1 cm자55조(50.9％),＜1 cm자53조.＜0.5 cm혹자위우선체배면자29조(26.9％),위후상신경외지고풍험분형,＞0.5 cm＜1 cm자24조(22.2％),갑상선상하경＞5 cm자중＜0.5 cm혹자위우선체배면비례현저증가.수술전후균행후경검사,일례술후출현발음저침등후상신경외지손상표현.결론 갑상선수술중신경감측기술가이정위후상신경외지적주행급기변이병지도수술자규피신경손상풍험.
Objective To evaluate the mechanism of external branch of the superior laryngeal nerve (EBSLN) injury during thyroid surgery as showed by intraoperative neuromonitoring.Methods 70 patients with 109 nerves at risk were enrolled in this study from March 2011 to October 2011.A positive signal is determined by observing contractions of the cricothyroid muscle.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.Results 108 nerves (99.1％) were located successfully,42 of which were visualized (38.9％).55 nerves (50.9％) crossed the superior thyroid artery more than 1 cm apart,while the other 53 nerves (49.1％) went less than 1 cm including 24 nerves(more than 0.5 cm,less than 1 cm) and 29 nerves (less than 0.5 cm) or coursed below the superior pole of the thyroid.The rate of the latter type was significantly elevated in patients with the top to botton diameter of the gland more than 5 cm.One patient suffered from impairing in the production of high tones postoperatively.Conclusions Intraoperative neuromonitoring is useful and helpful in providing instructive information for operations by locating EBSLN.