Khan A, Pearlman R C, Bianchi D A, Hauck K W
Department of Communication Sciences and Disorders, Howard University, Washington, DC, USA.
Am J Otolaryngol. 1997 Mar-Apr;18(2):99-102. doi: 10.1016/s0196-0709(97)90095-8.
To prevent damage to the recurrent laryngeal nerve during thyroid or parathyroid surgery, spontaneous and evoked electromyography (EMG) can be used to locate the recurrent laryngeal nerve or determine when the nerve is being disturbed. Two commercial electrodes have been introduced to receive laryngeal EMG. This study compares the clinical performance of the two electrodes.
The Xomed-Treace endotracheal tube electrode (Xomed-Treace, Jacksonville, FL) and the RLN postcricoid laryngeal electrode (RLN Systems, Jefferson City, MO) were placed concomitantly in 11 patients during 14 surgical procedures.
The RLN electrode provided feedback as to placement by providing a heart-beat artifact. The RLN electrode was found to be both more sensitive and more electrically noisy. On stimulation, the Xomed tube electrode produced generally higher EMG amplitudes, perhaps because of the different muscles they monitor. In one case, the Xomed tube failed to provide-EMG responses. Only at low electrical stimulation intensities could left and right vocalis muscles be identified with the Xomed tube. A laryngologist was needed to place the RLN electrode, whereas the attending anesthesiologist was able to place the Xomed tube.
Both electrodes provided useful EMG information and helped confirm the location of the recurrent laryngeal nerve. Who will place the electrode, tumors extrinsic or intrinsic to the larynx, cost, and size requirements should be considered when choosing an electrode.
为防止甲状腺或甲状旁腺手术中喉返神经受损，可使用自发肌电图和诱发肌电图（EMG）来定位喉返神经或确定神经何时受到干扰。已引入两种商用电极来接收喉部肌电图。本研究比较了这两种电极的临床性能。
在14例手术过程中，将Xomed-Treace气管内导管电极（Xomed-Treace，佛罗里达州杰克逊维尔）和喉返神经环状软骨后喉电极（RLN Systems，密苏里州杰斐逊城）同时放置在11例患者体内。
喉返神经电极通过产生心跳伪迹提供了关于放置位置的反馈。发现喉返神经电极更敏感且电噪声更大。在刺激时，Xomed导管电极通常产生更高的肌电图振幅，这可能是因为它们监测的肌肉不同。在1例病例中，Xomed导管未能提供肌电图反应。只有在低电刺激强度下，才能用Xomed导管识别左右声带肌。放置喉返神经电极需要一名喉科医生，而主治麻醉医生能够放置Xomed导管。
两种电极均提供了有用的肌电图信息，并有助于确认喉返神经的位置。选择电极时应考虑谁来放置电极、喉部肿瘤是外在性还是内在性、成本以及尺寸要求。
