喉返神经实时监测技术在甲状腺癌再次手术中的临床应用价值

李建华，付利军，李利文，郑守华，邱新光

(郑州大学第一附属医院普通外科，河南 郑州 450052)

[摘要]目的探讨利用喉返神经探测仪实时监测喉返神经技术在甲状腺癌再次手术中的使用方法及临床应用价值。方法对100例甲状腺癌再次手术患者在全麻手术中使用喉返神经探测仪进行喉返神经实时监测,并帮助寻找、鉴定喉返神经。结果100例再次手术的甲状腺癌患者中共成功探测并显露喉返神经190条，10例术前已证实有单侧声带麻痹患者术中未能探查到该侧喉返神经，190条喉返神经中成功寻找并鉴定179条，功能完整无损伤,11条因肿瘤侵犯予以剥离，术后11例患者新发声嘶，无患者出现呼吸困难。结论在甲状腺癌再次手术中利用喉返神经探测仪实时监测喉返神经有助于快速准确寻找、解剖和辨认喉返神经，并进一步客观评估喉返神经的功能，从而指导患者的围手术期治疗。

[关键词]神经监测;喉返神经;甲状腺癌；手术

DOI:10.3969/j.issn.1673-5412.2015.04.018

[中图分类号]R736.1;R730.56

作者简介：李建华(1982-)，男，主治医师，主要从事甲状腺肿瘤的临床诊治研究。E|mail:lijianhuadoctor@163.com

收稿日期：(2015-06-30)

Clinical Application Value of Intraoperative Neuromonitoring During the Reoperation for Thyroid Cancer

Li Jianhua,Fu Lijun,Li Liwen,Zheng Shouhua,Qiu Xinguang

(DepartmentofGeneralSurgery,theFirstAffiliatedHospitalofZhengzhouUniversity,Zhengzhou450052,China)

通信作者：邱新光(1963-),男，主任医师，主要从事甲状腺肿瘤的临床诊治研究。E|mail:qxg2000@126.com

Abstract[]ObjectiveTo summarize the clinical application value of intraoperative neuromonitoring during the reoperation for thyroid cancer.MethodsLaryngeal recurrent nerve detector was used for the intraoperative neuromonitoring and the exploration,identification of recurrent laryngeal nerve,during the reoperation for 100 patients with thyroid cancer under general anesthesia.ResultsDuring the reoperation for 100 patients with thyroid cancer,190 laryngeal recurrent nerve were detected and exposed successfully,10 laryngeal recurrent nerve were not detected which were damaged before the operation proved by the laryngoscope,179 of the 190 laryngeal recurrent nerve were detected and identified,11 laryngeal recurrent nerve were invaded by the tumor,and separated sucessfully,but the 11 patients appear voice hoarse,no dyspnea was observed.ConclusionIntraoperative neuromonitoring during the reoperation for thyroid cancer can help find,dissect and identify the laryngeal recurrent nerve,and further assess the function of the laryngeal recurrent nerve,so as to guide the perioperative treatment.

[Key words]neuromonitoring; recurrent laryngeal nerve; thyroid cancer; operation

甲状腺手术的关键技术之一就是喉返神经的分离和保护[1]，喉返神经损伤导致声音嘶哑或失声，严重时呼吸困难需要气管切开，严重降低了患者的生活质量，是甲状腺外科医患纠纷最常见原因。特别……