Wu Che-Wei, Wang Mei-Hui, Chen Cheng-Chien, Chen Hui-Chun, Chen Hsiu-Ya, Yu Jing-Yi, Chang Pi-Ying, Lu I-Cheng, Lin Yi-Chu, Chiang Feng-Yu
1 Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, 2 Faculty of Medicine, College of Medicine, 3 Department of Nursing, 4 Department of Anesthesiology, Kaohsiung Medical University Hospital, 5 Graduate Institute of Clinical Medicine, Graduate Institute of Medicine, 6 Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan.
Gland Surg. 2015 Feb;4(1):19-26. doi: 10.3978/j.issn.2227-684X.2014.12.03.
During recurrent laryngeal nerve (RLN) neuromonitoring in thyroid surgery, laryngeal electromyography (EMG) amplitude may be correlated with the number of muscle fibers participating in the polarization and these might be correlated with the function of RLN. If RLN is severely injured during the operation, most nerve fibers do not transmit nerve impulse and substantial decrease of EMG amplitude or loss of signal (LOS) will occur. True LOS at the end of an operation often indicates a postoperative fixed vocal cord, and the surgeon should consider the optimal contralateral surgery timing in patients with planned bilateral thyroid operation to avoid the disaster of bilateral vocal cord palsy. However, LOS recovery and false LOS may occur and may lead to an unnecessary 2(nd) operation. Therefore, a reliable modality for intraoperative LOS evaluation and management would afford the surgeon real-time information that could help guide surgical procedure and planning. The updated causes, algorithm, and management of LOS during RLN neuromonitoring are reviewed and summarized.
在甲状腺手术中进行喉返神经（RLN）神经监测时，喉肌电图（EMG）振幅可能与参与极化的肌纤维数量相关，而这些肌纤维数量可能与喉返神经的功能相关。如果在手术过程中喉返神经严重受损，大多数神经纤维无法传递神经冲动，肌电图振幅将大幅下降或出现信号丢失（LOS）。手术结束时真正的信号丢失通常表明术后声带固定，对于计划进行双侧甲状腺手术的患者，外科医生应考虑最佳的对侧手术时机，以避免双侧声带麻痹的灾难。然而，信号丢失恢复和假信号丢失可能会发生，并可能导致不必要的二次手术。因此，一种可靠的术中信号丢失评估和管理方法将为外科医生提供实时信息，有助于指导手术操作和规划。本文对喉返神经神经监测期间信号丢失的最新原因、算法和管理进行了综述和总结。
