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Интраоперационный нейромониторинг в тиреоидной хирургии

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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.

Ключевые слова:
интраоперационный нейромониторинг, эндокринная хирургия, возвратный гортанный нерв, наружная ветвь верхнего гортанного нерва, щитовидная железа.

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Intaoperative neuromonitoring in thyroid surgery

Thyroid surgery is most frequent interventions on endocrine organs. Whereas laryngeal nerves which innervate 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 permanent 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 intraoperative neuromonitoring going towards further investigation and improvement.

Keywords:
intraoperative neuromonitoring, endocire surgery, recurrence laryngeal nerve, external branch of superior laryngeal nerve, thyroid gland.