Vagal Stimulation during Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve in Thyroid Operation

在甲狀腺術中經迷走神經電刺激以偵測喉返神經功能

林澤義(Tse-Yi Lin) ； 陳慧君(Hui-Chun Chen) ； 陳秀雅(Hsiu-Ya Chen) ； 吳哲維(Che-Wei Wu) ； 江豐裕(Feng-Yu Chiang)

《台灣耳鼻喉頭頸外科雜誌》 46卷4期 (2011/08) Pp. 183-189

https://doi.org/10.6286/2011.46.4.183

摘要

背景：在甲狀腺手術中，使用喉返神經偵測器時，迷走神經電刺激之必要性仍是有爭議的。此一前瞻性之研究目的在决定迷走神經電刺激之安全性及其優點。方法：本篇收集289名接受甲狀腺手術且術中使用喉返神經偵測器之病人，其中包含了435條喉返神經。在術中剝離喉返神經之前後，均常規地做迷走神經電刺激，記錄其肌電圖訊號大小且分別定義其爲V1及V2訊號。結果：本研究中並未有因迷走神經電刺激而產生併發症之病例。在術中錄離喉返神經前，其迷走神經電刺激訊號（V1訊號），有6條迷走神經未測得，其中5次爲氣管內管上之電極位置有問題（在調整之後獲得V1訊號），另一次原因爲“非喉返神經”相關。在剝離喉返神經後之迷走神經電刺激訊號（V2訊號），有18條未測得，在術後監測聲帶活動功能，永久性聲帶麻痺有1名，暫時性聲帶麻痺有12名，另外5名其聲帶功能正常。其餘417條神經其V2訊號正常，術後聲帶功能正常。結論：在甲狀腺手術中伴隨喉返神經偵測器使用時，迷走神經電刺激爲一簡單且安全之步驟，可以發現術中喉返神經偵測器所有可能的人爲缺失。

關鍵字

喉返神經 ； 術中神經偵測器 ； 甲狀腺手術 ； 迷走神經電刺激 ； 前瞻性研究

並列摘要

BACKGROUND: The necessity of vagal stimulation during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) is still controversial. A prospective study to determine its safety and benefit is necessary.METHODS: 287 thyroid operations (435 RLNs at risk) with IONM were included. Vagal stimulation was performed routinely before and after dissection of RLN, and the evoked electromyography (EMG) signal was defined as V1 and V2 signal.RESULTS: No complication occurred due to the preparation and stimulation of vagus nerve. V1 was not obtainable in six nerves initially-five due to malposition of electrodes and one due to the non-RLN. Eighteen nerves experienced V2 loss, with one permanent palsy, 12 temporary palsy, and 5 normal vocal function postoperatively. The remaining 417 nerves with intact V2 all showed normal vocal function postoperatively.CONCLUSIONS: Vagal stimulation is a simple and safe procedure. It can easily uncover most kinds of artifacts during IONM.

並列關鍵字

recurrent laryngeal nerve ； intra-operative neuromonitoring ； thyroid operation ； vagal stimulation ； prospective study