Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
Department of Head, Neck and Maxillofacial Surgery, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
Langenbecks Arch Surg. 2019 Sep;404(6):703-709. doi: 10.1007/s00423-019-01825-7. Epub 2019 Nov 20.
During thyroid surgery, extreme caution is needed not to harm the recurrent laryngeal nerve and to avoid vocal cord palsy. Intra-operative neuromonitoring became increasingly popular as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN). Electromyographic (EMG) responses are normally recorded by electrodes attached to the endotracheal tube. Alteration in position can lead to false loss of signal. We developed thyroid cartilage electrodes that can be fixed directly onto the thyroid cartilage.
Prospective clinical cohort METHODS: Thyroid surgery with intra-operative neuromonitoring using both endotracheal tube-based electrodes and thyroid cartilage electrodes was performed in 25 patients undergoing thyroid surgery. EMG data were collected and reported as median and interquartile ranges (IQR), and the results were compared with the x Wilcoxon signed-rank test for paired measurements.
After stimulating vagal nerve (VN), recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), significantly higher EMG amplitudes were measured before and after thyroid resection for the thyroid cartilage (TC) electrodes, in all comparisons except for the right VN. At the level of the left EBSLN, median amplitude of 560 mV (IQR 190-1050) before and 785 mV (IQR 405-3670) after resection was noted. At the level of the right EBSLN, median amplitude of 425 μV (IQR 257-698) before and 668 mV (IQR 310-1425) after resection was noted. Median amplitudes of 760 mV (IQR 440-1180) and 830 mV (IQR 480-1490) were noted at the left RLN, median amplitudes of 695 mV (IQR 405-1592) and 1078 mV (IQR 434-1895) were noted at the right RLN.
Thyroid cartilage electrodes appear to be a feasible and reliable alternative for endotracheal electrodes.
甲状腺手术时，需要格外小心避免损伤喉返神经，避免发生声带麻痹。术中神经监测作为识别喉返神经（RLN）的金标准的辅助手段越来越受欢迎。肌电图（EMG）响应通常通过附接到气管内管的电极来记录。位置的改变可能导致信号的错误丢失。我们开发了可以直接固定在甲状软骨上的甲状腺软骨电极。
前瞻性临床队列研究
对 25 例行甲状腺手术的患者进行了术中神经监测，同时使用气管内管电极和甲状腺软骨电极。收集 EMG 数据并报告为中位数和四分位距（IQR），并使用 Wilcoxon 符号秩检验对配对测量结果进行比较。
在刺激迷走神经（VN）、喉返神经（RLN）和上喉神经外支（EBSLN）后，除右侧 VN 外，所有比较中，甲状腺软骨（TC）电极在甲状腺切除前后均测量到明显更高的 EMG 幅度。在左侧 EBSLN 水平，切除前的中位幅度为 560 mV（IQR 190-1050），切除后的中位幅度为 785 mV（IQR 405-3670）。在右侧 EBSLN 水平，切除前的中位幅度为 425 μV（IQR 257-698），切除后的中位幅度为 668 mV（IQR 310-1425）。左侧 RLN 的中位幅度为 760 mV（IQR 440-1180），右侧 RLN 的中位幅度为 830 mV（IQR 480-1490）。
甲状腺软骨电极似乎是气管内电极的一种可行且可靠的替代方案。
