田萌子　乐静鸿　郝敏　毕研青

【摘要】 目的：研究甲状腺手术中喉返神经肌电信号振幅改变及喉返神经损伤机制。方法：选取2014年3月-2016年3月本院接受治疗并进行甲状腺手术的患者220例，对患者在手术时进行神经肌电信号振幅改变研究及喉返神经的检测。在患者手术中检测左侧的喉返神经105条，右侧的喉返神经98条。结果：203条（左侧105条，右侧98条）神经中，17条（8.37%，左侧15条，右侧2条）神经在手术发生50%以上的喉部肌电图描记振幅降低；患者的损坏部位主要出现在下极水平、入喉处、腺体中部和Rp点近端，其中腺体中部的损伤较多；患者的损伤机制依次是牵引、钳夹、缝扎、卡压和热损伤。结论：在甲状腺手术中牵引损伤是最常见的损伤，其次是钳夹、缝扎、卡 压和热损伤；手术中在喉部肌电图描记振幅降低超过50%后暂停手术对恢复神经损伤有一定作用；在手术中规范化的神经检测系统可以减少患者发生永久性的神经损伤。

【关键词】 甲状腺手术； 神经检测系统； 喉返神经损伤机制

Study on the Changes of Recurrent Laryngeal Nerve EMG Amplitude and the Mechanism of Recurrent Laryngeal Nerve Injury during Thyroid Surgery/TIAN Meng-zi，LE Jing-hong，HAO Min，et al.//Medical Innovation of China，2017，14（06）：052-055

【Abstract】 Objective：To study the changes of nerve amplitude and the mechanism of recurrent laryngeal nerve injury in nerve monitoring of thyroid surgery.Method：220 patients with thyroid surgery underwent recurrent laryngeal nerve operation in our hospital from March 2014 to March 2016 were selected，the change of EMG signal amplitude and the detection of recurrent laryngeal nerve were studied.In the operation，105 cases of recurrent laryngeal nerve were left and the right recurrent laryngeal nerve was 98.Result：In the nerves of 203（the left side 105，the right side 98），17 nerves（8.37%，15 left，right 2） in the operation occurred more than 50% EMG amplitude decreased；the lesions were mainly located in the lower pole，at the larynx，in the middle part of the gland and proximal to the Rp point，and the damaged in the middle part of the gland more；the injury mechanism of the patient was traction，clamp，suture，compression and thermal injury.Conclusion：Traction injury is the most common injury in thyroid surgery，followed by clamp，suture，compression and thermal injury；after surgery，the reduction of EMG amplitude by more than 50% will have a certain effect on the recovery of nerve injury；in the standardization of nerve detection system can reduce the occurrence of permanent nerve injury in patients.

【Key words】 Thyroid surgery； Neurological detection system； Recurrent laryngeal nerve injury mechanism

First-authors address：The Peoples Hospital of Dongying，Dongying 257091，China

doi：10.3969/j.issn.1674-4985.2017.06.014

喉返神經麻痹（Recurrent laryngeal nerve palsy，RLNP）是甲状腺手术中比较严重的并发症，人体内除了环甲肌外其他的固有喉肌的运动都受到喉返神经的支配。而调节声带运动外展肌肉的麻痹是喉返神经损伤主要的体现，一侧的损坏导致患者声音的嘶哑，两侧的损坏会导致通气的障碍，严重的会有窒息死亡的危险[1-2]。在甲状腺手术中致使的喉返神经麻痹也是产生医疗纠纷的主要因素。所以，在手术中医生对喉返神经功能性的保护和解剖变异要非常重视。……