Stimulating Dissecting Instruments During Neuromonitoring of RLN in Thyroid Surgery
Stimulating Dissecting Instruments During Neuromonitoring of RLN in Thyroid Surgery
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DOI：
10.1002/lary.25251
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发表时间：
2015-12-01
期刊：
影响因子：
2.6
通讯作者：
Wu, Che-Wei
中科院分区：
文献类型：
--
作者：
Chiang, Feng-Yu;Lu, I-Cheng;Wu, Che-Wei
目的/假设：在甲状腺手术中对喉返神经（RLN）进行术中神经监测（IONM）时，需要在解剖仪器和刺激探头之间频繁切换，既麻烦又耗时。因此，结合使用这两种工具将是未来一个值得注意的方向。本研究旨在探讨在 IONM 期间使用结合手术解剖和神经刺激功能的刺激解剖仪器 (SDI) 的可行性和安全性。研究设计：前瞻性结果研究。方法：连续纳入 100 名具有 168 个 RLN 风险的患者。我们开发了 SDI 原型，并将其应用于早期检测 RLN 解剖危险阶段的不良肌电图变化。如果在解剖过程中出现显着的肌电图变化（幅度下降> 50％），则暂停手术操作并立即释放甲状腺牵引。结果：SDI的应用在所有病例中都是可行的，并且没有导致任何并发症。检测到 19 个 RLN 存在明显的肌电图变化，这是由 SDI 解剖过程中的牵引应力引起的，并且在释放甲状腺牵引后肌电图逐渐恢复。甲状腺切除术后，10个RLN在Berry韧带区域检测到神经传导薄弱点，但只有1个振幅降低79%的神经出现术后暂时性声带麻痹。结论：在甲状腺手术中RLN损伤的危险期，SDI的应用是一种简单有效的即时监测神经功能的方法。它为外科医生提供肌电图反应的实时反馈，并可作为早期检测牵引窘迫引起的不良肌电图变化的工具。
Objectives/Hypothesis: During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM.Study Design: Prospective outcomes research.Methods: One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease >50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately.Results: The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy.Conclusion: The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress.