喉上神经监测在改良Miccoli手术中的应用

doi:10.16139/j.1007-9610.2024.06.07

外科理论与实践 ›› 2024, Vol. 29 ›› Issue (06): 498-502.doi: 10.16139/j.1007-9610.2024.06.07

喉上神经监测在改良Miccoli手术中的应用

姚毅真^a, 李学庆^b, 李宇津^b, 朱浩然^b, 汤承辉^b()

复旦大学附属上海市第五人民医院 a.麻醉科，b普外科，上海 200240

收稿日期:2024-03-13 出版日期:2024-11-25 发布日期:2025-03-17
通讯作者: 汤承辉，E-mail: tch19810921@163.com
基金资助:
闵行区自然科学研究课题(2021MHZ025)

Application of intraoperative neuromonitoring of superior laryngeal nerve in modified Miccoli surgery

YAO Yizhen^a, LI Xueqing^b, LI Yujin^b, ZHU Haoran^b, TANG Chenghui^b()

Department of Anesthesiology, b. Department of General Surgery, Shanghai Fifth People's Hospital, Fudan University， Shanghai 200240， China

Received:2024-03-13 Online:2024-11-25 Published:2025-03-17

摘要/Abstract

摘要：

目的： 结合改良Miccoli术式和神经监测技术的优点，探讨在该方法下对喉上神经保护的可行性和手术安全性。方法： 将2021年6月1日至2023年5月31日200例甲状腺改良Miccoli手术病人随机分为观察组（n=100，应用喉上神经监测技术）和对照组（n=100，应用传统喉上神经保护技术）。观察指标包括手术相关指标和术后并发症发生。术中记录喉上神经外支(EBSLN)探查成功率及Cernea分型情况。术后1周和1个月分别进行嗓音障碍指数评估VHI调查问卷、嗓音听感评估GRBAS评估和VHI问卷调查。结果： 纳入研究的两组病人性别、年龄、肿瘤直径、病理类型、肿瘤位置、神经检测异常情况比例、手术时间、术中出血量、术后第1天引流量、住院时间、术后其他并发症发生差异无统计学意义（P>0.05），观察组术后嗓音障碍指数评估和嗓音听感评估（VHI调查问卷、GRBAS评估表）优于对照组（P<0.05）。结论： 结合改良Miccoli术式的辅助腔镜技术和神经监测技术的优点，可有效指导解剖暴露喉上神经外支，从而有效保护喉上神经功能。

关键词: 喉上神经, 神经监测, 改良Miccoli手术

Abstract:

Objective To explore the feasibility and surgical safety of protecting the superior laryngeal nerve by combining the advantages of the modified Miccoli procedure and neuromonitoring technology. Methods From June 1, 2021 to May 31, 2023, 200 patients undergoing modified Miccoli thyroid surgery were randomly divided into an observation group (n=100, using superior laryngeal nerve monitoring technology) and a control group (n=100, using traditional superior laryngeal nerve protection technology). Observational indicators included surgical-related indicators, and postoperative complications. The success rate of external branch of superior laryngeal nerve (EBSLN) exploration and Cernea classification were recorded intraoperatively. Conduct voice handicap index(VHI) questionnaire and GRBAS perceptual evaluation at 1 week and 1 month postoperatively. Results There were no statistically significant differences between the two groups in terms of gender, age, tumor diameter, pathological type, tumor location, proportion of nerve detection abnormalities, operative time, intraoperative blood loss, postoperative day 1 drainage volume, length of hospital stay, or other postoperative complications (P>0.05). However, postoperative voice self-assessment and subjective auditory evaluation, as measured by the VHI questionnaire and GRBAS scale, were significantly better in the observation group compared to the control group (P<0.05). Conclusions The combination of auxiliary endoscopic technology in modified Miccoli procedure and neuromonitoring technology can effectively guide the anatomical exposure of external branch of the superior laryngeal nerve, thereby effectively protect the function of the superior laryngeal nerve.

Key words: Superior laryngeal nerve, Neuromonitoring, Modified Miccoli surgery

中图分类号:

R653
R4

姚毅真, 李学庆, 李宇津, 朱浩然, 汤承辉. 喉上神经监测在改良Miccoli手术中的应用[J]. 外科理论与实践, 2024, 29(06): 498-502.

YAO Yizhen, LI Xueqing, LI Yujin, ZHU Haoran, TANG Chenghui. Application of intraoperative neuromonitoring of superior laryngeal nerve in modified Miccoli surgery[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 498-502.

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参考文献 12

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Item	Observation group（n=100）	Control group（n=100）	t/χ² value	P value
Gender: male/female	23(23.0)/77(77.0)	24(24.0)/76(76.0)	0.03	0.87
Age (year)	35.4±6.8	35.7±6.8	-0.1	0.81
Tumor diameter (cm)	1.6±0.4	1.6±0.5	0.2	0.72
Pathological type			0.1	0.73
Differentiated Carcinoma	67(67.0)	70(70.0)
Other benign lesions	33(33.0)	30(30.0)
Tumor location			0.1	0.67
Unilateral	76(76.0)	71(71.0)
Bilateral	24(24.0)	29(29.0)

Item	Observation group（n=100）	Control group（n=100）	t/χ² value	P value
Proportion of abnormal neurological findings	7(7.0)	8(8.0)	0.1	0.82
Surgery time (min)	73.1±9.3	70.4±5.5	0.1	0.62
Intraoperative blood loss (mL)	30.3±5.3	35.4±8.4	-0.2	0.85

Item	Observation group（n=100）	Control group（n=100）	t/χ² value	P value
Drainage volume on day 1 (mL)	27.0±1.2	25.0±2.4	-0.3	0.83
Length of hospital stay (d)	4.7±0.5	4.5±0.3	-0.3	0.76
Other complications	3（3.0）	4（4.0）	0.0	0.93
VHI questionnaire score	5.3±1.2	11.5±2.0	4.4	<0.01
GRBAS scale score	1.9±0.2	3.2±0.2	2.4	0.03

喉上神经监测在改良Miccoli手术中的应用

Application of intraoperative neuromonitoring of superior laryngeal nerve in modified Miccoli surgery

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