【摘要】：目的： 提出喉返神經(jīng)監(jiān)測(cè)的新參數(shù)振幅的相對(duì)值并進(jìn)行評(píng)估，希望能為甲狀腺手術(shù)喉返神經(jīng)監(jiān)測(cè)應(yīng)用提供新的定量依據(jù)，以提高神經(jīng)監(jiān)測(cè)技術(shù)的準(zhǔn)確性。 背景： 在復(fù)雜的高難度甲狀腺手術(shù)中，喉返神經(jīng)常難免發(fā)生損傷，這長(zhǎng)期以來(lái)一直困擾著甲狀腺外科醫(yī)生。術(shù)中神經(jīng)監(jiān)測(cè)技術(shù)應(yīng)運(yùn)而生并日漸完善。此項(xiàng)技術(shù)中，外科醫(yī)生可通過聲帶肌肌電信號(hào)變化對(duì)喉返神經(jīng)是否發(fā)生損傷，損傷部位，損傷程度及功能狀態(tài)進(jìn)行及時(shí)分析，，為外科醫(yī)生在甲狀腺手術(shù)中及時(shí)判斷喉返神經(jīng)損傷提供有效保障，美國(guó)內(nèi)分泌外科（AAES）已把INOM作為手術(shù)指南加以推廣。但其準(zhǔn)確性尚有待于進(jìn)一步提高，臨床應(yīng)用仍促進(jìn)在爭(zhēng)議。 方法： 回顧性分析我院1164例甲狀腺手術(shù)患者的神經(jīng)監(jiān)測(cè)數(shù)據(jù)，對(duì)振幅、及振幅的相對(duì)值進(jìn)行總結(jié)，并計(jì)算應(yīng)用不同參數(shù)時(shí)喉返神經(jīng)損傷的正確診斷率。 結(jié)論： 左右側(cè)、不同測(cè)量部位、不同測(cè)量方法（電流）、不同年齡、不同性別的振幅的相對(duì)值均無(wú)明顯差異。且喉返神經(jīng)監(jiān)測(cè)振幅的絕對(duì)值與相對(duì)值聯(lián)合使用可以將神經(jīng)監(jiān)測(cè)對(duì)于喉返神經(jīng)損傷的陽(yáng)性預(yù)測(cè)值由21.57%提高至51.22%，正確診斷指數(shù)為由55.23%提高80.41%。振幅聯(lián)合相對(duì)值能有效排除左右側(cè)、測(cè)量部位、測(cè)量方法（不同電流）、年齡、性別、給測(cè)量帶來(lái)的影響，與術(shù)中神經(jīng)監(jiān)測(cè)的其他指數(shù)聯(lián)合能降低喉返神經(jīng)損傷的誤診率及漏診率，可明顯提高喉返神經(jīng)損傷的診斷率。所以我們建議將振幅的相對(duì)值作為一個(gè)監(jiān)測(cè)指標(biāo)引入甲狀腺手術(shù)的神經(jīng)監(jiān)測(cè)中來(lái)。
[Abstract]:Aim: to present and evaluate the relative amplitude of the new parameter of recurrent laryngeal nerve (RLN) monitoring in order to provide a new quantitative basis for the application of RLN monitoring in thyroid surgery so as to improve the accuracy of nerve monitoring technique. Background: laryngeal regurgitation often occurs during complex and difficult thyroid surgery, which has long plagued thyroid surgeons. Intraoperative nerve monitoring technology emerges as the times require and is becoming more and more perfect. In this technique, surgeons can analyze whether or not the recurrent laryngeal nerve is damaged, where it is, the extent of injury and the state of its function through changes in myoelectric signals of the vocal cords. In order to provide an effective guarantee for surgeons to judge the recurrent laryngeal nerve injury in time during thyroid surgery, the (AAES) of secretory surgery in the United States has promoted INOM as a surgical guide. However, its accuracy has yet to be further improved, and its clinical application is still controversial. Methods: the nerve monitoring data of 1164 patients undergoing thyroid surgery in our hospital were analyzed retrospectively. The amplitude and the relative value of amplitude were summarized. The correct diagnosis rate of recurrent laryngeal nerve injury with different parameters was calculated. Conclusion: there is no significant difference in the relative value of amplitude between left and right, different measuring position, different measuring method (current), different age, different sex. Combined use of absolute and relative values of RLN monitoring amplitude can increase the positive predictive value of RLN monitoring to 51.22% from 21.57% to 51.22%, and the correct diagnostic index of RLN from 55.23% to 80.41%. The amplitude combined relative value can effectively exclude the effects of left and right side, measuring position, measuring method (different current), age, sex, and so on, on the measurement. Combined with other indexes of nerve monitoring during operation, the misdiagnosis rate and missed diagnosis rate of recurrent laryngeal nerve injury could be reduced, and the diagnostic rate of recurrent laryngeal nerve injury could be improved obviously. Therefore, we suggest that the relative value of amplitude should be used as a monitoring index in the neural monitoring of thyroid surgery.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R653

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 孫輝;侯信明;付言濤;張大奇;周樂;劉秀云;張廣;張德恒;;甲狀腺手術(shù)中喉返神經(jīng)的顯露保護(hù)技巧[J];中國(guó)地方病防治雜志;2009年06期

2 張少?gòu)?qiáng);李隨勤;閆利英;趙繼元;白艷霞;姚小寶;;甲狀腺手術(shù)中喉返神經(jīng)顯露的意義[J];中國(guó)耳鼻咽喉頭頸外科;2006年06期

3 韋偉;韓彬;李朋;于志強(qiáng);何和平;;術(shù)中喉返神經(jīng)監(jiān)測(cè)系統(tǒng)在甲狀腺開放手術(shù)中的應(yīng)用[J];中國(guó)耳鼻咽喉頭頸外科;2010年01期

4 葉進(jìn);李鵬;方和平;王濤;黃子真;劉賢;張革化;;甲狀腺手術(shù)喉返神經(jīng)損傷危險(xiǎn)因素及應(yīng)對(duì)策略[J];中國(guó)耳鼻咽喉頭頸外科;2012年03期

5 王洵;劉錦峰;石寶玉;車昌文;戴金升;劉茉;王寧宇;;非返性喉返神經(jīng)的臨床所見及文獻(xiàn)回顧[J];中國(guó)耳鼻咽喉頭頸外科;2014年03期

6 王健;;喉不返神經(jīng)的術(shù)前診斷及術(shù)中損傷的預(yù)防[J];江蘇醫(yī)藥;2011年08期

7 屈新才;肖勇;黃韜;程波;石嵐;王國(guó)斌;;甲狀腺癌患者術(shù)中喉返神經(jīng)的顯露及損傷預(yù)防[J];中國(guó)癌癥雜志;2008年09期

8 高明;魏松鋒;李亦工;鄭向前;;喉不返神經(jīng)在甲狀腺外科手術(shù)中的解剖特點(diǎn)及臨床意義[J];中國(guó)實(shí)用外科雜志;2008年07期

9 張平;張浩;李璇;丁奎;羅英偉;馬文峰;辛世杰;;非返性喉返神經(jīng)的術(shù)前判定及術(shù)中處理[J];中國(guó)實(shí)用外科雜志;2010年08期

10 潘三強(qiáng);呂來(lái)清;;右側(cè)喉不返神經(jīng)1例及文獻(xiàn)回顧[J];中國(guó)臨床解剖學(xué)雜志;2010年01期

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