喉返神经的电生理识别

Electrophysiological identification of nonrecurrent laryngeal nerves.

作者信息

Kandil Emad, Anwar Muhammad A, Bamford Jeremy, Aslam Rizwan, Randolph Gregory W

机构信息

Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.

出版信息

Laryngoscope. 2017 Sep;127(9):2189-2193. doi: 10.1002/lary.26407. Epub 2016 Nov 15.

DOI:10.1002/lary.26407

PMID:27861937

Abstract

OBJECTIVES/HYPOTHESIS: The nonrecurrent laryngeal nerve (NRLN) is a common anatomic variation of the right recurrent laryngeal nerve (RLN), which has been associated with an increased risk of injury during thyroid and parathyroid surgery. We suggest that early successful identification using intraoperative nerve monitoring (IONM) and preservation of this variant will help the surgeon to avoid injury to this nerve. Our objective was to examine the electrophysiological parameters of the NRLN and the efficacy of IONM for successful identification of the NRLN.

STUDY DESIGN

Retrospective database analysis.

METHODS

This is a retrospective study of a prospectively collected database of all patients who underwent thyroid and parathyroid surgeries by a single surgeon at a tertiary care center over 3 years (n = 481). Patients' demographic data and operative reports, including the IONM reports, were reviewed. Average stimulation thresholds with resulting amplitudes and latencies were compared. Preoperative and postoperative laryngoscopy were performed in all cases.

RESULTS

We identified 15 NRLNs (2.2%) in a total 682 laryngeal nerves. No left-sided NRLNs were observed. The average right vagus latency in the NRLN group was shorter than that of the RLN group (2.40 ms ± 0.49 ms vs. 3.43 ms ± 1.03 ms; P < .001). No statistically significant difference was observed between the initial amplitudes of the right vagus nerves in the two groups (713.67 μV ± 208.71 μV vs. 816.22 μV ± 470.45 μV; P = .14). All NRLN cases exhibited normal functioning of vocal cords on postoperative laryngoscopy.

CONCLUSIONS

IONM is highly effective in the identification of the NRLN. Right vagus nerve latency in the NRLN group was found to be significantly shorter than in the RLN group. Early identification of the NRLN allowed cautious preservation of the NRLN, resulting in excellent postoperative outcomes. The rate of NRLN identification may be improved by routine use of IONM.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:2189-2193, 2017.

摘要

目的/假设：非返喉神经（NRLN）是右喉返神经（RLN）常见的解剖变异，与甲状腺和甲状旁腺手术中神经损伤风险增加有关。我们认为术中神经监测（IONM）早期成功识别并保留该变异神经将有助于外科医生避免损伤此神经。我们的目的是研究NRLN的电生理参数以及IONM成功识别NRLN的有效性。

研究设计

回顾性数据库分析。

方法

这是一项对某三级医疗中心一名外科医生在3年内进行的所有甲状腺和甲状旁腺手术患者的前瞻性收集数据库的回顾性研究（n = 481）。回顾了患者的人口统计学数据和手术报告，包括IONM报告。比较了平均刺激阈值以及由此产生的振幅和潜伏期。所有病例均进行了术前和术后喉镜检查。

结果

在总共682条喉神经中，我们识别出15条NRLN（2.2%）。未观察到左侧NRLN。NRLN组右侧迷走神经的平均潜伏期短于RLN组（2.40 ms±0.49 ms对3.43 ms±1.03 ms；P <.001）。两组右侧迷走神经的初始振幅之间未观察到统计学上的显著差异（713.67 μV±208.71 μV对816.22 μV±470.45 μV；P = 0.14）。所有NRLN病例术后喉镜检查显示声带功能正常。