影響腮腺切除手術中偵測顏面神經反應之因素

Interferential Factors of Facial Nerve Response Detection during Parotidectomy

柯建安(Chien-An Ko) ； 簡志彥(Chin-Yen Chien) ； 莊蕙青(Hui-Ching Chuang)

《台灣耳鼻喉頭頸外科雜誌》 56卷3期 (2021/09) Pp. 147-154

https://doi.org/10.6286/jtohns.202109_56(3).147

摘要

背景：本研究主要目的為探討腮腺切除手術，可能影響顏面神經探測器與顏面神經反應偵測的相關因素，並建立可靠的顏面神經反應預測值，提升手術中顏面神經探測器監測品質。方法：回溯性分析51名於2013年11月至2015年12月期間，接受腮腺腫瘤切除手術，且術中使用顏面神經探測器之病患，分析病患性別、年齡、體重、腮腺腫瘤部位與深度、腮腺切除體積、腮腺腫瘤大小、肌肉鬆弛劑給予的藥物劑量及定位顏面神經主幹之花費時間，與顏面神經偵測反應之相關性。結果：本研究共有51名病患參與，47名（92.2%）患者組織病理報告為良性腮腺腫瘤，4名（7.8%）則為惡性腮腺腫瘤，手術後發生暫時性顏面神經麻痺的機率為19.6%，而90%顏面神經受損之病患均於3個月內完全恢復正常功能，永久性顏面神經麻痺機率為1.9%。男性之初始顏面神經偵測反應平均值（739.6 μV）明顯高於女性之反應平均值（443.4 μV, p=0.025），而腮腺組織切除體積大小（Pearson correlation coefficient: r = 0.302, p=0.031）、肌肉鬆弛劑施打至分離顏面神經主幹之時間差（Pearson correlation coefficient: r=0.406, p=0.003）與顏面神經震幅比值具有明顯相關性，可以採用神經震幅比值用來預測手術後顏面神經功能。結論：合併顏面神經初始偵測之神經反應及腫瘤完整切除後之神經反應，所得之神經震幅比值，更適合用於預測術後顏面神經麻痺的受損和恢復程度。如果神經震幅比值大於一，則患者可能有較高機率出現術後顏面神經麻痺。

關鍵字

facial nerve ； facial nerve monitor ； facial nerve paralysis ； parotidectomy（顏面神經 ； 顏面神經探測器 ； 顏面神經麻痺 ； 腮腺切除手術）

並列摘要

BACKGROUND: The study aimed to analyze interferential factors in detecting the facial nerve response during parotidectomy. We tried to establish reliable prediction values for the facial nerve response to improve the quality of facial nerve monitoring. METHODS: We enrolled 51 patients who underwent parotidectomy using intraoperative facial nerve monitoring in this retrospective study between Nov. 2013 and Dec. 2015. The correlation between multiple factors of detected nerve responses, including patients' sex, age, weight, parotid tumor site and depth, resection volume of the parotid gland, tumor volume, dosage of muscle relaxant, and the time between relaxant administration and facial nerve identification, were analyzed. RESULTS: A total of 47 of the 51 patients (92.2%) had benign parotid tumors, and 4 (7.8%) had malignant tumors. The incidence of temporary facial nerve paralysis after surgery was 19.6%, and 90% of patients with facial nerve damage had fully restored normal function within three months. The incidence of permanent facial nerve paralysis rate was 1.9%. The initial detected facia nerve response was significantly higher in males (Mean 739.6 V) than females (443.4V, p = 0.025). The detection of the facial nerve response was significantly correlated to the resection volume of the parotid tissue (Pearson correlation coefficient: r = 0.302, p = 0.031) and the time between muscle relaxant administration and facial nerve identification (Pearson correlation coefficient: r = 0.406, p = 0.003). The amplitude ratio of the facial nerve response can be used to predict the function of the facial nerve after surgery. CONCLUSIONS: The amplitude ratio of the nerve response, combining the initial detected facial nerve response and the final detected nerve response after complete removal of the whole tumor, is suitable for predicting the grading of facial nerve injury and the recovery of facial nerve paralysis after surgery. If the amplitude ratio is larger than one, the patient may have a higher chance of postoperative facial nerve paralysis.

並列關鍵字

facial nerve ； facial nerve monitor ； facial nerve paralysis ； parotidectomy