Preview

Эндокринная хирургия

Расширенный поиск

Интраоперационный нейромониторинг в тиреоидной хирургии

https://doi.org/10.14341/serg2013332-40

Полный текст:

Аннотация

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.

Об авторе

P Rumyantsev

доктор мед. наук, зам. директора ФГБУ “Эндокринологический научный центр” Минздрава России.


Список литературы

1. Donatini G, Carnaille B, Dionigi G. Increased detection of nonrecurrent inferior laryngeal nerve (NRLN) during thyroid surgery using systematic intraoperative neuromonitoring (IONM). World J Surg. 2013;1:91-93.

2. Zambudio AR, Rodriguez J, Riquelme J et al. Prospective study of postoperative complications after total thyroidecto my for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004;1:18-25.

3. Filho JG, Kowalski LP. Postoperative complications of thy roidectomy for differentiated thyroid carcinoma. Am J Otolaryngol. 2004;4:225-230.

4. Karamanakos SN, Markou KB, Panagopoulos K et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens). 2010;4:318-325.

5. MarcheseRagona R, Restivo DA, Mylonakis I et al. The supe rior laryngeal nerve injury of a famous soprano, Amelita Galli Curci. Acta Otorhinolaryngol Ital. 2013;1:67-71.

6. Cernea CR, Ferraz AR, Furlani J et al. Identification of the external branch of the superior laryngeal nerve during thy roidectomy. Am J Surg. 1992;6:634-639.

7. Hwang SB, Lee HY, Kim WY et al. The anatomy of the exter nal branch of the superior laryngeal nerve in Koreans. Asian J Surg. 2013;1:13-19.

8. Mishra AK, Temadari H, Singh N et al. The external laryngeal nerve in thyroid surgery: the 'no more neglected' nerve. Indian J Med Sci. 2007;1:3-8.

9. Barczynski M, Konturek A, Stopa M et al. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg. 2012;6:1340-1347.

10. LochWilkinson TJ, Stalberg PL, Sidhu SB et al. Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg. 2007;5:377-380.

11. Hermann M, Alk G, Roka R et al. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002;2:261-268.

12. Hvidegaard T, Vase P, Dalsgaard SC, Jorgensen K. Endo laryngeal devices for perioperative identification and func tional testing of the recurrent nerve. Otolaryngol Head Neck Surg. 1984;3:292-294.

13. Echeverri A, Flexon PB. Electrophysiologic nerve stimulation for identifying the recurrent laryngeal nerve in thyroid surgery: review of 70 consecutive thyroid surgeries. Am Surg. 1998;4:328-333.

14. Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World J Surg. 2004;8:755-760.

15. Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;4:443-449.

16. Mermelstein M, Nonweiler R, Rubinstein EH. Intraoperative identification of laryngeal nerves with laryngeal electromyog raphy. Laryngoscope. 1996;6:752-756.

17. Ulmer C, Koch KP, Seimer A et al. Real-time monitoring of the recurrent laryngeal nerve: an observational clinical trial. Surgery. 2008;3:359-365.

18. Ulmer C, Friedrich C, Kohler A et al. Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery. Head Neck. 2011;7:976-984.

19. Potenza AS, Phelan EA, Cernea CR et al. Normative Intra operative Electrophysiologic Waveform Analysis of Superior Laryngeal Nerve External Branch and Recurrent Laryngeal Nerve in Patients Undergoing Thyroid Surgery. World J Surg. 2013;10:2336-2342.

20. Thomusch O, Sekulla C, Walls G et al. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002;6:673-678.

21. Dralle H, Sekulla C, Haerting J et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;6:1310-1322.

22. Sari S, Erbil Y, Sumer A et al. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg. 2010;6: 474-478.

23. Zheng S, Xu Z, Wei Y et al. Effect of intraoperative neuromo nitoring on recurrent laryngeal nerve palsy rates after thyroid surgery. A metaanalysis. J Formos Med Assoc. 2013;8: 463-472.

24. Witt RL. Recurrent laryngeal nerve electrophysiologic monitoring in thyroid surgery: the standard of care? J Voice. 2005;3:497-500.

25. Snyder SK, Hendricks JC. Intraoperative neurophysiology testing of the recurrent laryngeal nerve: plaudits and pitfalls. Surgery. 2005;6:1183-1191; discussion 1191-1182.

26. Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery. 2006; 6:866-872; discussion 872-863.

27. Terris DJ, Anderson SK, Watts TL, Chin E. Laryngeal nerve monitoring and minimally invasive thyroid surgery: complementary technologies. Arch Otolaryngol Head Neck Surg. 2007;12:1254-1257.

28. Atallah I, Dupret A, Carpentier AS et al. Role of intraoperative neuromonitoring of the recurrent laryngeal nerve in highrisk thyroid surgery. J Otolaryngol Head Neck Surg. 2009; 6:613-618.

29. Chiang FY, Lee KW, Chen HC et al. Standardization of intra operative neuromonitoring of recurrent laryngeal nerve in thy roid operation. World J Surg. 2010;2:223-229.

30. Barczynski M, Konturek A, Stopa M et al. Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir. 2011;4:196-203.

31. Chiang FY, Lu IC, Tsai CJ et al. Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury? Evidence from the application of intraoperative neuromonitoring. Am J Otolaryngol. 2011;6:499-503.

32. Duclos A, Lifante JC, Ducarroz S et al. Influence of intraope rative neuromonitoring on surgeons' technique during thy roidectomy. World J Surg 2011; 4:773-778.

33. Parmeggiani D, De Falco M, Avenia N et al. Nerve sparing sutureless total thyroidectomy. Preliminary study. Ann Ital Chir. 2012;2:91-96.

34. Alesina PF, Rolfs T, Hommeltenberg S et al. Intraoperative neuromonitoring does not reduce the incidence of recurrent laryngeal nerve palsy in thyroid reoperations: results of a retrospective comparative analysis. World J Surg. 2012; 6:1348-1353.

35. Barczynski M, Konturek A, Pragacz K et al. Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study. World J Surg. 2013. Oct 1. [Epub ahead of print]

36. Dionigi G, Boni L, Rovera F et al. Neuromonitoring and video assisted thyroidectomy: a prospective, randomized case control evaluation. Surg Endosc. 2009;5:996-1003.

37. Barczynski M, Konturek A, Cichon S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009;3:240-246.


Для цитирования:


. Интраоперационный нейромониторинг в тиреоидной хирургии. Эндокринная хирургия. 2013;7(3):32-40. https://doi.org/10.14341/serg2013332-40

For citation:


Rumyantsev P.O. Intaoperative neuromonitoring in thyroid surgery. Endocrine Surgery. 2013;7(3):32-40. (In Russ.) https://doi.org/10.14341/serg2013332-40

Просмотров: 43


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2306-3513 (Print)
ISSN 2310-3965 (Online)