References

endoserg

Эндокринная хирургия

Endocrine Surgery

2306-35132310-3965

Типография «Печатных дел Мастер»

10.14341/serg2013332-40

endoserg-6374

Research Article

Статьи

Articles

Интраоперационный нейромониторинг в тиреоидной хирургии

Intaoperative neuromonitoring in thyroid surgery

Rumyantsev

P O

doktor med. nauk, zam. direktora FGBU “Endokrinologicheskiy nauchnyy tsentr” Minzdrava Rossii.

pavelrum@gmail.com

2013

15092013

№3 (2013)

3240

2013

Rumyantsev P.O.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.surg-endojournals.ru/jour/article/view/6374

Операции на щитовидной железе являются самыми частыми в хирургии эндокринных органов. Учитывая прохождение в этой зоне гортанных нервов, иннервирующих мышцы гортани, чрезвычайно актуальны снижение риска их повреждения и гарантии функциональной сохранности. В первую очередь в зону риска попадает возвратный гортанный нерв, который в 0,5–2,7% случаев может не иметь “возвратный” ход, а напрямую отходить от блуждающего нерва на уровне перcтневидного хряща. Во вторую очередь – наружная ветвь верхнего гортанного нерва, которая иннервирует щитоперстневидную мышцу. Рутинное применение интраоперационного нейромониторинга достоверно снижает частоту временных парезов гортанных нервов, однако достоверность снижения частоты стойких параличей гортанных нервов не подтверждена в большинстве опубликованных исследований. При этом все авторы признают, что интраоперационный нейромониторинг безусловно облегчает обнаружение гортанных нервов и позволяет убедиться в их функциональной сохранности. Учитывая, что вопросы безопасности хирургического лечения являются парадигмой современной эндокринной хирургии, метод интраоперационного нейромониторинга продолжает всесторонне изучаться и совершенствоваться.

Thyroid surgery is most frequent interventions on endocrine organs. Whereas laryngeal nerves which inner vate the muscles of larynx are passing nearby the thyroid and central compartment therefore the risk of their injury and functional integrity is extremely important. First of all it is recurrent laryngeal nerve which in 0.5–2.7% has not “recurrent” path and depart vagus at cricoid cartilage level. Secondary it is external branch of superior laryngeal nerve with innervates cricothyroid muscle. Routine use of intraoperative neuromonitoring significantly decrease laryngeal nerves temporary palsy (paresis) rate however significant reduction of perma nent palsy frequency was not demonstrated in most published papers. At the same time all authors accept that intraoperative neuromonitoring undoubtedly facilitate detection of laryngeal nerves and allow to convince their functional capacity. Taking into account that safety is a paradigm of contemporary endocrine surgery the intra operative neuromonitoring going towards further investigation and improvement.

интраоперационный нейромониторингэндокринная хирургиявозвратный гортанный нервнаружная ветвь верхнего гортанного нерващитовидная железа

intraoperative neuromonitoringendocire surgeryrecurrence laryngeal nerveexternal branch of superior laryngeal nervethyroid gland

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The authors declare that there are no conflicts of interest present.