一種創新的經甲狀軟骨施行術中喉返神經監測的方法應用於甲狀腺手術—轉譯豬模型研究及臨床創新應用

A novel trans-thyroid-cartilage recording method for intraoperative neural monitoring of recurrent laryngeal nerve in thyroid surgery- Translation Porcine Model Research and Clinical New Applications

Enkhtuvshin Zesendavaa(Enkhtuvshin Zesendavaa)

指導教授 ： 江豐裕

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2019年)

摘要

一種創新的經甲狀軟骨施行術中喉返神經監測的方法應用於甲狀腺手術—轉譯豬模型研究及臨床創新應用

摘要
背景
術中神經監測已被廣泛被接受為有用的輔助工具應於甲狀腺手術中辨識保護喉返神經。術中神經監測過程中通常使用氣管內管電極進行喉部肌電圖記錄。然而在臨床使用時，時常有不少的缺點被報告。因此新的喉部肌電圖監測方法是必要的。由於聲帶肌來自甲腺軟骨的內表面。我們臆設甲腺軟骨上的電極可以提供更穩定和可靠的肌電訊號。
材料與方法
利用豬模型研究經甲狀軟骨肌電圖監測方法，並轉譯應用於臨床甲狀腺手術。動物實驗中使用6頭小豬(12條喉返神經及12條迷走神經)，比較氣管內管電極和甲狀軟骨電極監測的肌電訊號。隨後的臨床應用研究中，160名甲狀腺手術病人接受甲狀軟骨電極來監測術中喉返神經及迷走神經的肌電訊號(V1-R1-R2-V2)。

結果
在動物研究中，氣管內管電極和甲狀軟骨電極都可穩定的監測到喉返神經及迷走神經肌電訊號。在喉返神經刺激下，氣管內管電極和甲狀軟骨電極偵測的肌電訊號平均振幅分別為1086±165μv 和1860±276μV。在迷走神經刺激下，平均振幅分別為952±172μv 和1557±266μv。
在臨床研究中，所有病人都可利用甲狀軟骨電極偵測到穩定可靠的肌電訊號(V1-R1-R2-V2)，平均振幅分別為1950±945μv、2627±1292μv、2803±1305μv 和 1970±1006μv。在本臨床研究中沒有故障排除或併發症的發生。
結論
本動物和臨床研究證實此創新的術中監測的可行性與可靠性。此甲狀軟骨肌電訊號監測方法提供一種簡單、方便、可靠、不貴的術中神經監測於甲狀腺手術。
關鍵字: 術中神經監測;喉返神經;肌電圖;甲狀腺軟骨;甲狀腺手術

關鍵字

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並列摘要

Abstract
Background
Intraoperative neural monitoring (IONM) has been accepted as a useful adjunct to help identify recurrent laryngeal nerve (RLN) during thyroid surgery. The laryngeal electromyography (EMG) recording during IONM of RLN is usually performed by using endotracheal tube (ETT) electrodes. Several limitations were reported during using ETT electrodes in clinical practice. Therefore, a novel alternative EMG recording method is necessary. We hypothesize that recoding electrodes on outer thyroid cartilage (TC) may provide more stable and reliable EMG signals, since vocalis muscles originate from the inner surface of TC.

Materials and methods
A trans-thyroid-cartilaginous EMG recording method was investigated in a porcine model and subsequently clinically applied in human thyroid surgery. In the animal experiment, six pigs (12 nerve sides) were used to compare EMG signal recordings between the use of ETT electrodes and TC electrodes. In a subsequent clinical application study, 160 patients (303 RLNs at risk) receiving monitored thyroidectomy were enrolled. The EMG signals (V1-R1-R2-V2) were recorded through TC electrodes alone.

Results
In animal study, typical laryngeal EMG waveforms were well recorded in the ETT electrodes and TC electrodes stimulated with 1mA of stimulus current on both sides of RLNs and vagus nerves (VNs). Under RLN stimulation, the mean amplitudes of EMG signals recorded by the ETT electrodes and TC electrodes were 1086 ± 165μV and 1860 ± 276μV, respectively. Under VN stimulation, the mean amplitudes were 952 ± 172μV and 1557 ± 266μV, respectively.
In clinical study, stable EMG signals and typical waveforms were detected by the TC electrodes. The mean EMG amplitudes were 1950 ± 945μV, 2627 ± 1292μV, 2803 ± 1305 μV and 1970 ± 1006 μV for V1, R1, R2 and V2 signals, respectively. There was no episode of troubleshooting or complications from TC electrodes in this clinical study.
Conclusions
The animal and clinical studies confirmed the feasibility of using TC electrodes for recording laryngeal EMG signals. The novel trans-thyroid-cartilaginous EMG recording method was convenient, user friendly, reliable and inexpensive during IONM of RLN in thyroid surgery.

並列關鍵字

IONM: Intraoperative neural monitoring ； EMG: Electromyography ； RLN: Recurrent laryngeal nerve ； TC: Thyroid cartilage ； TS: Thyroid surgery

參考文獻

References

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