CN115581521A - Nerve monitoring system suitable for thyroid tumor ablation and using method thereof - Google Patents

Abstract

The invention relates to a nerve monitoring system suitable for thyroid tumor ablation and a using method thereof, and the nerve monitoring system comprises a nerve stimulation needle, wherein the nerve stimulation needle comprises a conductive needle rod and an insulating needle handle, one end of the conductive needle rod is provided with a conductive needle point, and the outer surface of the conductive needle rod is provided with an insulating layer; the nerve monitoring instrument comprises a host and a display screen, wherein the host is connected with a nerve stimulating needle through a first lead and used for providing a stimulating signal, the host is connected with a recording electrode through a second lead and used for monitoring an electromyogram signal, and the display screen is connected with the host and used for displaying an electromyogram; the system can be used in cooperation with the existing ablation system and the ultrasonic system, and can monitor whether the recurrent laryngeal nerve or the vagus nerve is damaged in real time in the ablation operation, so that a doctor can timely find whether the recurrent laryngeal nerve or the vagus nerve is damaged or not in the ablation operation, the continuous damage to the nerve in the ablation operation can be effectively prevented, and the purpose of protecting the recurrent laryngeal nerve and the vagus nerve is achieved.

Description

Nerve monitoring system suitable for thyroid tumor ablation and using method thereof

Technical Field

The invention relates to the technical field of ablation surgery, in particular to a nerve monitoring system suitable for thyroid tumor ablation surgery.

Background

Multiple groups of nerves pass through the neck of a human body, and in the surgical treatment of neck diseases, such as the treatment of thyroid diseases, the nerve tissues need to be protected as much as possible to reduce the surgical complications; for example, the recurrent laryngeal nerve branches from the vagus nerve, turns back to the sides of the neck trachea, ascends in close proximity to the thyroid gland, and enters the laryngeal cavity near the thyroid cartilage, where it can manage the laryngeal muscles other than the cricothyroid muscle. As is known, the nerve tissue of the human body can not be regenerated, and if the recurrent laryngeal nerve is damaged in the operation, the vocal cords can not move normally, so that the patient can be hoarse, and the life quality is influenced.

In the anatomical structure of the human body, the thyroid is located below the thyroid cartilage in the neck of the human body and on both sides of the trachea, is shaped like a butterfly, just like a placoid, and is generally divided into a left and a right lobes and an isthmus, wherein the left and the right lobes are located on both sides of the lower part of the larynx and the upper part of the organ, the upper end of the left and the right lobes extends from the middle point of the thyroid cartilage, the lower end of the left and the right lobes extends to the 6 th tracheal cartilage ring, and sometimes reaches the suprasternal fossa or behind the sternum. Thyroid tumors are common tumors of the head and the neck, and can be treated by surgery or thermal ablation, but because the thermal ablation is not required to be dissected, the thyroid tumors are applied more and more in the treatment of the thyroid tumors.

In the prior art, in the ablation of thyroid tumor, an ablation system and an ultrasonic system are generally used, wherein the ablation system comprises an ablation needle and an ablation host, the ablation needle is connected with the ablation host through a lead, and the ablation host is used for providing energy for a thermal ablation process; during the treatment process, a patient is usually in a local anesthesia state, medical staff can see the thyroid tumor and the ablation needle through the ultrasonic system, so that under the real-time guidance of the ultrasonic system, the ablation needle is inserted into the thyroid tumor (or in an ablation area), the ablation host is started, the temperature near the ablation needle point reaches above 60 ℃, the tumor is ablated by heat, and the purpose of treatment is achieved. Since the recurrent laryngeal nerve and the vagus nerve are usually attached to the surrounding tissues, especially the recurrent laryngeal nerve is usually attached to the thyroid gland, and may be closely spaced to the thyroid tumor, special attention is required by medical personnel when ablating thyroid tumors to prevent damage to the recurrent laryngeal nerve.

To avoid the ablation process from damaging the recurrent laryngeal nerve or vagus nerve as much as possible, the conventional approach is: a doctor can judge whether the recurrent laryngeal nerve is damaged or not by talking with a patient and knowing the sound change of the patient in an operation, once the patient has hoarse voice, the patient indicates that the recurrent laryngeal nerve is damaged, the position of the ablation needle should be immediately adjusted to avoid the recurrent laryngeal nerve from being continuously damaged, and therefore the purpose of protecting the nerve can be achieved to a certain extent. Based on this, the prior art discloses some nerve monitoring systems, so that during the ablation, a doctor can monitor whether the recurrent laryngeal nerve is damaged by using the nerve monitoring system, but the nerve monitoring system is difficult to find by the doctor at the initial stage of the damage, for example, a monitoring system capable of monitoring the recurrent laryngeal nerve disclosed in chinese patent CN 109528297A includes an ablation needle, an ablation host, a tracheal catheter and a nerve monitor, wherein the ablation needle is connected with the ablation host through a host line and is connected with the nerve monitor through a probe line, the tracheal catheter is provided with a recording electrode, the recording electrode is connected with the nerve monitor through a conducting wire, and before the operation, the tracheal catheter needs to be inserted through the throat of the patient, and the recording electrode is in contact with the vocal cords of the patient. In the ablation operation, a doctor inserts an ablation needle into thyroid gland, parathyroid gland or other neck tumor tissues under the guidance of ultrasound, firstly opens a nerve monitor, closes an ablation host, generates stimulation current by the needle point of the ablation needle, excites nerve potential if the needle point is close to recurrent laryngeal nerve or vagus nerve, contracts target laryngeal muscles, triggers vocal cord vibration, generates myoelectric signals, receives the myoelectric signals by a recording electrode positioned in the vocal cords, transmits the myoelectric signals back to the nerve monitor, and displays electromyogram through filtering and amplification. The nerve monitoring system can only judge whether the recurrent laryngeal nerve or the vagus nerve exists around the needle point before the ablation is started, and because the ablation is realized by utilizing heat energy in the ablation process, the heat energy can radiate in a certain range, and the heat energy is invisible, and whether the radiation range of the heat energy covers the recurrent laryngeal nerve or the vagus nerve can not be intuitively judged, a doctor can not timely find whether the recurrent laryngeal nerve or the vagus nerve is damaged in the ablation process, and the continuous damage of the nerve is easily caused. In conclusion, how to effectively protect the recurrent laryngeal nerve and the vagus nerve and prevent the nerves from being continuously damaged in the thyroid tumor ablation operation still needs to be solved.

Disclosure of Invention

The invention provides a nerve monitoring system suitable for thyroid tumor ablation, which is used together with the existing ablation system and can monitor whether the recurrent laryngeal nerve or the vagus nerve is damaged in real time in the ablation process so that a doctor can timely regulate and control the ablation system to avoid continuously damaging the nerve, thereby achieving the purpose of protecting the recurrent laryngeal nerve and the vagus nerve, and the main conception is as follows:

a nerve monitoring system suitable for thyroid tumor ablation comprises a nerve stimulation needle for applying stimulation signals, wherein the nerve stimulation needle comprises a conductive needle rod and an insulating needle handle arranged on the conductive needle rod, one end of the conductive needle rod is provided with a conductive needle point, and the outer surface of the conductive needle rod is provided with an insulating layer;

the recording electrode is attached to the skin at the thyroid cartilage and is used for collecting myoelectric signals; and

the nerve monitor comprises a host and a display screen, wherein the host is connected with a nerve stimulating needle through a first lead and used for providing a stimulating signal, the host is connected with a recording electrode through a second lead and used for monitoring an electromyogram signal, and the display screen is in communication connection with the host and at least used for displaying an electromyogram formed by the electromyogram signal. According to the nerve monitoring system, the nerve stimulation needle is configured, and is connected with the host of the nerve monitoring instrument, the nerve monitoring instrument can provide stimulation signals for the nerve stimulation needle, and the stimulation signals can be released to the position of the conductive needle tip through the conductive needle tip of the nerve stimulation needle, so that the problem of nerve stimulation is solved; the electromyogram monitoring system is characterized in that a recording electrode is configured and connected with a host of a nerve monitor so as to collect electromyogram signals by using the recording electrode, the host can monitor the change condition of the electromyogram signals according to the collected electromyogram signals and can display electromyograms in real time through a display, and the problem of monitoring the neural electromyogram signals in real time is solved; the nerve monitoring system can be matched with the existing ablation system and an ultrasonic system for use, so that in the thyroid tumor ablation, a doctor can timely find whether the recurrent laryngeal nerve or the vagus nerve is damaged or not through the real-time change condition of electromyogram, and can timely close or adjust the ablation system after finding that the nerve is damaged, thereby effectively preventing the nerve from being continuously damaged in the ablation, and achieving the purpose of protecting the recurrent laryngeal nerve and the vagus nerve.

In order to solve the problem of monitoring whether the recurrent laryngeal nerve is damaged, further, the distance between the conductive needle tip and the insulating needle handle is larger than or equal to 8 cm. So that the conductive needle tip of the nerve stimulating needle can be inserted into the vicinity of the recurrent laryngeal nerve to monitor whether the recurrent laryngeal nerve is damaged.

Preferably, the distance between the conductive needle point and the insulating needle handle is 10 cm.

In order to solve the problem of disposable use of the nerve stimulation needle, in the first scheme, one end of the first lead is connected to the insulating needle handle, the first lead is electrically connected with the conductive needle rod, the other end of the first lead is provided with a first plug, the host is provided with a first jack matched with the first plug, and the first plug is connected with the first jack in a pluggable mode. Through the cooperation of first plug and first jack, can be convenient realize first wire and the host computer be connected with the separation to be convenient for change the nerve stimulation needle alone, so that realize the disposable of nerve stimulation needle.

In the second scheme, one end of the first lead is connected with the conductive clamp, the insulating needle handle is provided with a conductive head matched with the conductive clamp, and the conductive head is electrically connected with the conductive needle rod. When the nerve stimulation needle is used, after the nerve stimulation needle is inserted in place, the first lead and the nerve stimulation needle can be communicated only by clamping the conductive clamp on the conductive head, so that the nerve stimulation needle is convenient to use and disassemble and replace.

Preferably, the two recording electrodes are connected with the host through two second leads.

In order to solve the problem of disposable use of the recording electrode, one end of a second lead is connected to the recording electrode, a second plug is arranged at the other end of the second lead, the host is provided with a second jack matched with the second plug, and the second plug can be connected with the second jack in a pluggable mode. Through the cooperation of second plug and second jack, can be convenient realize the second wire with the host computer be connected with the separation to be convenient for change recording electrode and second wire alone, so that realize recording electrode's disposable.

For better collection of electromyographic signals, the recording electrode further comprises an insulation base layer and a conducting strip arranged on the insulation base layer, the conducting strip is connected with the second lead, and a needle point is arranged on one side, deviating from the insulation base layer, of the conducting strip. The recording electrode is inserted into the skin of a patient by using the needle point, so that the recording electrode can be prevented from falling off, the recording electrode is more firmly arranged, and the recording electrode is closer to the thyroid cartilage, thereby being more beneficial to acquiring the electromyographic signals.

Furthermore, the nerve monitor also comprises an alarm which is connected with the host, and when the monitored myoelectric signal is lower than the set threshold value, the host controls the alarm to give an alarm. In order to remind the doctor.

Preferably, the insulating layer is an insulating coating. Not only can realize insulating effect, can avoid increasing the external diameter of electrically conductive needle bar moreover as far as possible for electrically conductive needle bar is smaller and more exquisite, more convenient to use.

Further, the grounding electrode is connected with the host through a third lead.

Furthermore, the one end of third wire is connected in telluric electricity field, and the other end of third wire is provided with the third plug, the host computer disposes the third jack of adaptation third plug, the pluggable third jack of connection of third plug.

The second aspect of the invention further solves the problem of preventing damage to the recurrent laryngeal nerve or vagus nerve during the process of ablating thyroid tumor, further comprises an extension tube, wherein the conductive needle rod is provided with a channel along the axial direction of the conductive needle rod, the side wall of the conductive needle tip is provided with an opening, the opening is communicated with the channel,

one end of the extension tube is connected with the nerve stimulation needle and communicated with the channel, and the other end of the extension tube is provided with a connector matched with the nipple of the injector. In the thyroid tumor ablation, the conducting needle tip of the nerve stimulation needle can be inserted at a position close to the recurrent laryngeal nerve or the vagus nerve and is positioned between the thyroid tumor and the recurrent nerve or the vagus nerve, and a doctor can infuse physiological saline into the position where the conducting needle tip is positioned through the extension tube, so that on one hand, the injection of the physiological saline can increase the distance between the thyroid tumor and the recurrent laryngeal nerve or the vagus nerve, thereby preventing the recurrent laryngeal nerve or the vagus nerve from being damaged in the process of ablating the thyroid tumor, and being particularly suitable for the occasion that the thyroid tumor is very close to the recurrent laryngeal nerve or the vagus nerve; on the other hand, the physiological saline can form separation between the thyroid tumor and the recurrent laryngeal nerve or the vagus nerve, has the function of cooling, and can effectively prevent the recurrent laryngeal nerve or the vagus nerve from being damaged by heat in the thyroid tumor ablation process.

In order to solve the problem of reflux, the extension tube is further provided with a switch for controlling on/off, and the switch is a medical clamping device, a medical one-way valve or a medical three-way infusion tube. The switch is used for controlling the on/off of the extension tube, so that the backflow of the infused normal saline can be prevented under the action of internal pressure, and the pressure of the infused normal saline can be maintained, thereby more stably playing a role in separating nerves from thyroid tumors.

The nerve monitoring system comprises a nerve stimulation needle, a recording electrode and a nerve monitor, wherein the nerve stimulation needle comprises a conductive needle rod and an insulating needle handle arranged on the conductive needle rod, one end of the conductive needle rod is provided with a conductive needle point, and the outer surface of the conductive needle rod is provided with an insulating layer; the nerve monitoring instrument comprises a host and a display screen, the host is connected with a nerve stimulating needle through a first lead, the host is connected with a recording electrode through a second lead, the display screen is in communication connection with the host, the using method comprises the following steps,

inserting the conductive needle tip of the nerve stimulating needle near recurrent laryngeal nerve or vagus nerve, attaching the recording electrode to the skin at the thyroid cartilage,

the host is started, the host is utilized to provide a stimulation signal to the nerve stimulation needle, the stimulation signal is released out through the conductive needle tip,

the recording electrode is used for collecting the electromyographic signal and transmitting the electromyographic signal to the host,

and monitoring the electromyographic signals by using a host, and displaying the electromyographic signals on a display screen in an electromyogram manner. Therefore, whether the recurrent laryngeal nerve or the vagus nerve is damaged or not is continuously monitored in the thyroid tumor ablation operation, so that the problem of continuous damage of the nerve is prevented, and the aim of protecting the recurrent laryngeal nerve and the vagus nerve is fulfilled.

In the case of a nerve monitoring system configured with a ground electrode, the method of use further includes applying the ground electrode to the skin of the upper arm of the patient.

In the case of a nerve monitoring system configured with an extension tube, the method of use further includes infusing saline through the extension tube to the location where the electrically conductive needle tip is located, with the infused saline forming a barrier between the electrically conductive needle tip and the recurrent laryngeal nerve or vagus nerve. Can further prevent heat damage to recurrent laryngeal nerve or vagus nerve during thyroid tumor ablation.

Compared with the prior art, the nerve monitoring system suitable for the thyroid tumor ablation can be matched with the existing ablation system and an ultrasonic system for use, and can monitor whether the recurrent laryngeal nerve or the vagus nerve is damaged in real time in the ablation, so that a doctor can timely find whether the recurrent laryngeal nerve or the vagus nerve is damaged or not through the nerve monitoring system in the thyroid tumor ablation, the nerve can be effectively prevented from being continuously damaged in the ablation, and the aim of protecting the recurrent laryngeal nerve and the vagus nerve is fulfilled.

Drawings

In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings required in the embodiments will be briefly described below, it should be understood that the following drawings only illustrate some embodiments of the present invention and therefore should not be considered as limiting the scope, and those skilled in the art can also obtain other related drawings based on the drawings without inventive efforts.

Fig. 1 is a schematic view of a nerve monitoring system according to embodiment 1 of the present invention.

Fig. 2 is a schematic cross-sectional view of a human neck (throat).

Fig. 3 is a schematic diagram of a nerve stimulation needle, a recording electrode and a grounding electrode in a nerve monitoring system in place during thyroid tumor ablation.

Fig. 4 is a schematic diagram of an ablation system used in conjunction with the present nerve monitoring system in a thyroid tumor ablation procedure.

Fig. 5 is a side view of a recording electrode in a nerve monitoring system according to embodiment 3 of the present invention.

Fig. 6 is an exploded schematic view of a nerve monitoring system according to embodiment 4 of the present invention.

Fig. 7 is a schematic structural diagram of a nerve stimulation needle in a nerve monitoring system according to embodiment 5 of the present invention.

Fig. 8 is a schematic view illustrating a conductive clip being clamped to a conductive head of a nerve stimulation needle in a nerve monitoring system according to embodiment 5 of the present invention.

Fig. 9 is a schematic structural diagram of a nerve stimulation needle in the nerve monitoring system according to embodiment 6 of the present invention.

Fig. 10 is a schematic view of a thyroid tumor ablation procedure after injecting saline solution into a region between the thyroid gland and the recurrent laryngeal nerve using an injector and a nerve stimulating needle.

Description of the drawings

Nerve stimulation needle 100, conductive needle rod 101, conductive needle tip 102, insulating needle handle 103, insulating layer 104, first lead 105, first plug 106, conductive clip 107, groove 108, conductive head 109, opening 110, channel 111, extension tube 112, interface 113, internal thread 114, switch 115

Recording electrode 200, insulating base layer 201, conductive sheet 202, needle point 203, second wire 204, second plug 205

A ground electrode 300, a third lead 301, a third plug 302

Host 401, display screen 402, patch panel 403, first jack 404, second jack 405, and third jack 406

Ablation system 500, ablation needle 501 and ablation host 502

Ultrasonic probe 600

Syringe 700, nipple 701

Thyroid gland 801, thyroid tumor 802, recurrent laryngeal nerve 803, vagus nerve 804, trachea 805, esophagus 806, common carotid artery 807, internal jugular vein 808, skin 809, physiological saline 810, and upper arm 811.

Detailed Description

The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. The components of embodiments of the present invention generally described and illustrated in the figures herein may be arranged and designed in a wide variety of different configurations. Thus, the following detailed description of the embodiments of the present invention, presented in the figures, is not intended to limit the scope of the invention, as claimed, but is merely representative of selected embodiments of the invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments of the present invention without making any creative effort, shall fall within the protection scope of the present invention.

Example 1

In the present embodiment, firstly, a nerve monitoring system is provided, which comprises a nerve stimulating needle 100, a recording electrode 200 and a nerve monitor, wherein,

the nerve stimulation needle 100 is mainly used for applying a stimulation signal, and in practice, the nerve stimulation needle 100 comprises a conductive needle rod 101 and an insulating needle handle 103 arranged on the conductive needle rod 101, as shown in fig. 1, the conductive needle rod 101 may preferably be a cylindrical rod, one end of the conductive needle rod 101 is provided with a conductive needle point 102, and the outer surface of the conductive needle rod 101 is provided with an insulating layer 104, so that the conductive needle point 102 is exposed to the outside to release the stimulation signal. In implementation, the insulating layer 104 may be an insulating coating, which not only can achieve an insulating effect, but also can avoid increasing the outer diameter of the conductive needle rod 101 as much as possible, so that the conductive needle rod 101 is smaller and more convenient to use; the insulating coating may be formed by coating the outer surface of the conductive needle bar 101 with an existing insulating paint (or insulating varnish). Of course, in practice, the insulating layer 104 may also be an insulating sleeve sleeved outside the conductive needle rod 101, so as to achieve the purpose of insulation.

In this embodiment, the nerve monitoring instrument may be an existing nerve monitoring instrument, which generally includes a host 401 and a display 402, as shown in fig. 1, the display 402 is communicatively connected to the host 401 for communicating with each other, the host 401 is connected to the nerve stimulation needle 100 through a first wire 105, specifically, the first wire 105 is electrically connected to the conductive needle rod 101 of the nerve stimulation needle 100, and the host 401 is mainly used for providing a stimulation signal, so that the stimulation signal can be transmitted to the conductive needle tip 102 of the nerve stimulation needle 100 through the first wire 105 and finally released from the conductive needle tip 102. In implementation, the display screen 402 and the host 401 may be separated from each other and connected by a wire, or the display screen 402 may be directly configured on the host 401, so that the display screen 402 and the host 401 are connected into a whole. It can be understood that the host 401 is usually configured with a processor, a stimulation signal generation module, a storage module, a power supply module, etc., the processor is electrically connected to the stimulation signal generation module, the storage module, and the power supply module respectively, the stimulation signal generation module is used for generating a stimulation signal under the control of the controller, and the first lead 105 is connected to the stimulation signal generation module so as to transmit the stimulation signal.

When in use, the recording electrode 200 can be attached to the skin of the thyroid cartilage of a patient and is mainly used for acquiring the electromyographic signals, for example, the recording electrode 200 can acquire the laryngeal myoelectric signals of the patient, and the host 401 can be connected with the recording electrode 200 through the second lead 204 so as to transmit the acquired electromyographic signals to the host 401. For example, the second wire 204 may be electrically connected to a processor in the host 401, so as to extract, analyze and store the collected electromyographic signals by using the processor for the purpose of monitoring the electromyographic signals, the host 401 may further form the received electromyographic signals into an Electromyogram (EMG), and the display screen 402 may be communicatively connected to the processor in the host 401, so that the display screen 402 may at least display the electromyogram formed by the electromyographic signals.

In this embodiment, the recording electrode 200 may be an existing electrode sheet, for example, the recording electrode 200 includes an insulating base layer 201 and a conductive sheet 202 disposed on the insulating base layer 201, the conductive sheet 202 is connected to the second conductive line 204, and the insulating base layer 201 may be made of an insulating material such as non-woven fabric.

In practice, the number of the recording electrodes 200 may be one, two or more, and as shown in fig. 1, the present nerve monitoring system may include two recording electrodes 200, and the two recording electrodes 200 are respectively connected to the host 401 through two second wires 204.

In a more sophisticated embodiment, the present neural monitoring system further includes a ground electrode 300, as shown in fig. 1, the ground electrode 300 may be connected to a host 401 through a third wire 301, so as to implement a grounding function. The number of ground electrodes 300 may be adapted to the number of recording electrodes 200, and in use, the ground electrodes 300 may be provided on the skin of the upper arm 811 of the patient.

In the embodiment, the insulating needle handle 103 is mainly convenient for a user to hold, the position of the insulating needle handle 103 may be determined according to actual requirements, for example, the insulating needle handle 103 may be disposed at the other end of the conductive needle rod 101, as shown in fig. 1, one end of the first conducting wire 105 may be connected to the insulating needle handle 103, and the first conducting wire 105 is electrically connected to the conductive needle rod 101. Since the vagus nerve 804 is located closer to the surface of the patient's body, and the recurrent laryngeal nerve 803 is located further from the surface of the patient's body, as shown in fig. 2, in accordance with the physiology at the neck of the human body; in this embodiment, the distance between the conductive tip 102 and the insulating needle handle 103 may be greater than or equal to 8 cm, so that the conductive tip 102 of the nerve stimulating needle 100 may be inserted into the vicinity of the recurrent laryngeal nerve 803 in order to monitor whether the recurrent laryngeal nerve 803 is damaged. In a preferred embodiment, the distance between the conductive tip 102 and the insulating needle handle 103 may be 8-20 cm, and in this embodiment, the distance between the conductive tip 102 and the insulating needle handle 103 is 10 cm. In order to control the insertion depth of the nerve stimulation needle 100, the surface of the conductive needle rod 101 is provided with scale marks along the length of the conductive needle rod 101. In the present embodiment, the diameter of the conductive needle bar 101 may be 1.5mm to 2.0mm.

The nerve monitoring system can be used with an existing ablation system 500 and a medical ultrasonic imaging system, for convenience of description, the existing ablation system 500 comprises an ablation needle 501 and an ablation host 502, the ablation needle 501 is connected with the ablation host 502 through a lead, the ablation host 502 is used for providing energy for a thermal ablation process, and the ablation needle 501 is used for releasing ablation energy. The existing medical ultrasonic imaging system is a method and a technology for obtaining visible images of human tissue properties and structures by irradiating a human body with ultrasonic waves and receiving and processing echoes with characteristic information of the human tissue or structural properties, and is widely applied in the medical field; the conventional medical ultrasonic imaging system generally includes an ultrasonic probe 600, a data processing terminal connected to the ultrasonic probe 600, and a display connected to the data processing terminal, wherein the ultrasonic probe 600 is mainly used for transmitting and receiving ultrasonic waves, and the display can display the formed image for the purpose of visualization. As a typical method of use, shown in fig. 2, which is a cross-sectional view of a patient's larynx, before performing ablation of a thyroid tumor 802, a physician may use an ultrasound imaging system to view the location of the thyroid tumor 802, recurrent laryngeal nerve 803, vagus nerve 804, etc., as shown in fig. 2, where the thyroid tumor 802 is located near the recurrent laryngeal nerve 803; then, the doctor may insert the conductive tip 102 of the nerve stimulation needle 100 under the guidance of ultrasound to a position near the recurrent laryngeal nerve 803 so that the conductive tip 102 is located between the recurrent laryngeal nerve 803 and the thyroid tumor 802, as shown in fig. 3; then, the doctor can attach the two recording electrodes 200 to the skin of the patient at the left and right two thyroid cartilages, respectively, as shown in fig. 3, and attach the ground electrode 300 to the skin of the patient's upper arm 811; then, the nerve monitor is started, the nerve monitor continuously or intermittently outputs stimulation signals, the stimulation signals are output through the conductive needle tip 102 of the nerve stimulation needle 100, the recurrent laryngeal nerve 803 nearby is stimulated, the nerve potential can be excited, the laryngeal muscle is contracted, vocal cord vibration is triggered, and an electromyogram signal is generated, can be received by the recording electrode 200 and is transmitted back to the nerve monitor, and the electromyogram can be displayed in the display screen 402 after the processing of filtering, amplification and the like of the nerve monitor. Then, under the guidance of ultrasound, the doctor can insert the ablation needle 501 in the ablation system 500 into the thyroid tumor 802 (or into the ablation region), as shown in fig. 4, the ablation host 502 is activated, so that the temperature near the tip of the ablation needle 501 reaches above 60 ℃, so as to ablate the tumor by using heat, thereby achieving the purpose of treatment. In the process, the nerve monitoring system can continuously acquire and display electromyography so as to realize real-time monitoring, so that a doctor can check the change condition of the electromyography in real time through the display screen 402 in the whole ablation operation, and once the electromyography signal in the electromyography is found to be lower than a set threshold value, the recurrent laryngeal nerve 803 is damaged, and at the moment, the doctor can timely close or adjust the ablation system 500 so as to prevent the ablation needle 501 from continuously damaging the recurrent laryngeal nerve 803 and achieve the purpose of protecting the recurrent laryngeal nerve 803.

Example 2

The main difference between this embodiment 2 and the foregoing embodiments is that in the nerve monitoring system provided in this embodiment, the nerve monitor further includes an alarm, the alarm is connected to the host 401, and when the monitored myoelectric signal is lower than the set threshold, the host 401 controls the alarm to alarm. More specifically, the alarm may be connected to a processor in the host 401, and when the processor detects that the electromyographic signal is lower than the set threshold, it indicates that the recurrent laryngeal nerve 803 or the vagus nerve 804 is damaged, and at this time, the processor may control the alarm to alarm so as to remind the doctor.

Example 3

The main difference between this embodiment 3 and the above-mentioned embodiments is that in the nerve monitoring system provided in this embodiment, in the recording electrode 200, the needle point 203 is disposed on the side of the conductive sheet 202 away from the insulating base layer 201, as shown in fig. 5, so as to be inserted into the skin of the patient by using the needle point 203, the needle point 203 is conductive, and the material of the needle point 203 may be the same as that of the conductive sheet 202, which can prevent the recording electrode 200 from falling off, so that the recording electrode 200 is disposed more firmly, and the recording electrode 200 is closer to the thyroid cartilage, thereby being more beneficial to collecting the electromyographic signals.

Example 4

For the convenience of disposable use, the main difference between this embodiment 4 and the above embodiments is that in the nerve monitoring system provided in this embodiment, one end of the first lead 105 is connected to the insulating needle handle 103, the first lead 105 is electrically connected to the conductive needle rod 101, and the other end of the first lead 105 is provided with the first plug 106, as shown in fig. 6, meanwhile, the host 401 is provided with the first socket 404 adapted to the first plug 106, the first plug 106 is connected to the first socket 404 in a pluggable manner, and in actual use, the first lead 105 and the host 401 can be conveniently connected and disconnected by the cooperation of the first plug 106 and the first socket 404, so that the nerve stimulation needle 100 can be conveniently replaced individually, and the disposable use of the nerve stimulation needle 100 can be realized.

Similarly, one end of the second wire 204 is connected to the recording electrode 200, the other end of the second wire 204 is provided with the second plug 205, meanwhile, the host 401 is configured with the second jack 405 adapted to the second plug 205, and the second plug 205 is connected to the second jack 405 in a pluggable manner, so that in actual use, through the cooperation of the second plug 205 and the second jack 405, the connection and separation of the second wire 204 and the host 401 can be conveniently realized, thereby facilitating the individual replacement of the recording electrode 200 and the second wire 204, and further realizing the disposable use of the recording electrode 200.

Similarly, one end of the third wire 301 is connected to the grounding electrode 300, the other end of the third wire 301 is provided with the third plug 302, meanwhile, the host 401 is configured with the third jack 406 adapted to the third plug 302, and the third plug 302 is connected to the third jack 406 in a pluggable manner, so that in actual use, through the cooperation of the third plug 302 and the third jack 406, the connection and separation of the third wire 301 and the host 401 can be conveniently realized, and the grounding electrode 300 can be used for one time.

In practice, the first jack 404, the second jack 405, and the third jack 406 may be directly configured in the host 401, or may be configured in a single patch panel 403, for example, as shown in fig. 6, the first jack 404, the second jack 405, and the third jack 406 are respectively configured in the patch panel 403, and the first jack 404, the second jack 405, and the third jack 406 of the patch panel 403 may be respectively connected to the host 401 through wires, and when in use, the first plug 106, the second plug 205, and the third plug 302 only need to be respectively inserted into the corresponding first jack 404, the second jack 405, and the third jack 406 to achieve communication between the first wire 105, the second wire 204, and the third wire 301 and the host 401, which is very convenient, at this time, the host 401 in the nerve monitor may adopt the host 401 in the existing NIM 3.0 nerve monitor, and the patch panel 403 in the existing NIM 3.0 nerve monitor may be adopted.

Example 5

For the convenience of disposable use, the main difference between this embodiment 5 and the above embodiments is that in the nerve monitoring system provided in this embodiment, one end of the first wire 105 is connected to the conductive clip 107, and the other end can be directly connected to the host 401, or a first plug 106 can be provided to communicate with the host 401 through the cooperation between the first plug 106 and the first jack 404; the insulating needle handle 103 is provided with a conductive head 109 matched with the conductive clip 107, and the conductive head 109 is electrically connected with the conductive needle rod 101. When the nerve stimulation needle 100 is used, after the nerve stimulation needle 100 is inserted in place, the first lead 105 can be communicated with the nerve stimulation needle 100 only by clamping the conductive clamp 107 on the conductive head 109, so that the nerve stimulation needle is convenient to use and is convenient to detach and replace.

The conductive head 109 may have various embodiments, for example, the conductive head 109 may be a conductive tab disposed on the insulating needle shaft 103, the conductive tab has a sheet structure, and the clamping opening of the conductive clamp 107 may be configured to be flush so as to clamp the conductive tab. For another example, as shown in fig. 7, one end of the conductive needle rod 101 may extend out of the insulating needle handle 103 and form the conductive head 109, that is, the conductive head 109 and the insulating needle handle 103 are an integral structure, and the conductive head 109 is cylindrical, at this time, a groove 108 is formed in the holding port of the conductive clip 107, as shown in fig. 7 and fig. 8, so as to fit the conductive head 109, so that the conductive head 109 can be stably held.

In this way, only the nerve stimulation needle 100 needs to be replaced each time the nerve stimulation needle is used, which is more beneficial to saving cost.

Example 6

In order to prevent damage to the recurrent laryngeal nerve 803 or the vagus nerve 804 during ablation of the thyroid tumor 802, the nerve monitoring system of this embodiment 6 mainly differs from the above embodiments in that the nerve monitoring system of this embodiment further includes an extension tube 112, the extension tube 112 may be preferably a flexible tube, and the conductive needle 101 is configured with a channel 111 along its axial direction, as shown in fig. 9 and 10, the side wall of the conductive needle tip 102 is configured with an opening 110, the opening 110 is communicated with the channel 111, one end of the extension tube 112 is connected to the nerve stimulation needle 100 and is communicated with the channel 111, for example, the channel 111 penetrates through the end of the conductive needle 101 away from the conductive needle tip 102, one end of the extension tube 112 may be connected to the insulating needle handle 103 of the nerve stimulation needle 100 and is communicated with the channel 111, as shown in fig. 9, the other end of the extension tube 112 is configured with a port 113 adapted to the nipple of the syringe 700. In the thyroid tumor 802 ablation, the conductive needle tip 102 of the nerve stimulation needle 100 may be inserted at a position close to the recurrent laryngeal nerve 803 or the vagus nerve 804 and located between the thyroid gland 801 and the recurrent laryngeal nerve 803 or the vagus nerve 804, as shown in fig. 10, a physician may infuse saline 810 into the position where the conductive needle tip 102 is located through the extension tube 112, as shown in fig. 10, on one hand, the saline may be infused to increase the distance between the thyroid tumor 802 and the recurrent laryngeal nerve 803 or the vagus nerve 804, so as to prevent the recurrent laryngeal nerve 803 or the vagus nerve 804 from being damaged in the process of ablating the thyroid tumor 802, especially in the case where the thyroid tumor 802 is close to the recurrent laryngeal nerve 803 or the vagus nerve 804; on the other hand, the physiological saline 810 can form a barrier between the thyroid tumor 802 and the recurrent laryngeal nerve 803 or the vagus nerve 804, as shown in fig. 10, and has a cooling effect, so that the recurrent laryngeal nerve 803 or the vagus nerve 804 can be effectively prevented from being damaged by heat in the ablation process of the thyroid tumor 802.

In practice, the interface 113 may be a threaded interface 113 configured with internal threads 114, as shown in fig. 9, to fit a syringe 700 nipple having external threads; the port 113 may also be a tapered or circular hole to fit the nipple of a syringe 700 that is not provided with external threads.

In order to prevent the saline from flowing back, in a further embodiment, the extension tube 112 is further provided with a switch 115 for controlling on/off, so that the switch 115 is used to control on/off of the extension tube 112, thereby preventing the infused saline from flowing back under the action of internal pressure, and maintaining the pressure of the infused saline, so as to more stably separate the nerve from the thyroid tumor 802. In practice, the switch 115 may be a medical clamp, a medical check valve, a medical infusion tee, or the like commonly used in the art, as shown in fig. 9 and 10, so that the extension tube 112 is closed by the switch 115 after the injection is completed.

Without being limited thereto, any person skilled in the art can easily conceive of changes or substitutions within the technical scope of the present disclosure, and all such changes or substitutions are intended to be included within the scope of the present disclosure.

Claims (10)

1. A nerve monitoring system suitable for thyroid tumor ablation is characterized by comprising a nerve stimulation needle for applying stimulation signals, wherein the nerve stimulation needle comprises a conductive needle rod and an insulating needle handle arranged on the conductive needle rod, one end of the conductive needle rod is provided with a conductive needle point, and the outer surface of the conductive needle rod is provided with an insulating layer;

the recording electrode is attached to the skin at the thyroid cartilage and used for collecting myoelectric signals; and

the nerve monitor comprises a host and a display screen, wherein the host is connected with a nerve stimulating needle through a first lead and used for providing a stimulating signal, the host is connected with a recording electrode through a second lead and used for monitoring an electromyogram signal, and the display screen is in communication connection with the host and at least used for displaying an electromyogram formed by the electromyogram signal.

2. The nerve monitoring system suitable for thyroid tumor ablation according to claim 1, wherein the distance between the conductive needle tip and the insulating needle handle is greater than or equal to 8 cm.

3. The nerve monitoring system suitable for thyroid tumor ablation according to claim 2, wherein the distance between the conductive needle tip and the insulating needle handle is 10 cm.

4. The nerve monitoring system suitable for thyroid tumor ablation according to claim 1, wherein one end of the first conducting wire is connected to the insulating needle handle, the first conducting wire is electrically connected with the conductive needle rod, a first plug is arranged at the other end of the first conducting wire, the host is provided with a first jack adapted to the first plug, and the first plug is connected with the first jack in a pluggable manner;

or the like, or, alternatively,

one end of the first lead is connected with a conductive clamp, the insulating needle handle is provided with a conductive head matched with the conductive clamp, and the conductive head is electrically connected with the conductive needle rod.

5. The nerve monitoring system suitable for thyroid tumor ablation according to claim 1, wherein one end of the second wire is connected to the recording electrode, the other end of the second wire is provided with a second plug, the host is configured with a second jack adapted to the second plug, and the second plug is connected with the second jack in a pluggable manner.

6. The nerve monitoring system suitable for thyroid tumor ablation according to claim 1, further comprising a ground electrode, wherein the ground electrode is connected to the host computer through a third wire.

7. The nerve monitoring system suitable for thyroid tumor ablation according to claim 6, wherein one end of the third wire is connected to the ground electrode, the other end of the third wire is provided with a third plug, and the host computer is provided with a third jack adapted to the third plug, and the third plug is connected to the third jack in a pluggable manner.

8. The nerve monitoring system suitable for thyroid tumor ablation according to any one of claims 1 to 7, wherein the recording electrode comprises an insulating base layer and a conducting strip disposed on the insulating base layer, the conducting strip is connected to the second conducting wire, and a needle point is disposed on a side of the conducting strip away from the insulating base layer,

and/or the nerve monitor also comprises an alarm which is connected with the host, and when the monitored electromyographic signals are lower than the set threshold value, the host controls the alarm to give an alarm.

9. The nerve monitoring system suitable for thyroid tumor ablation according to any one of claims 1 to 7, further comprising an elongated tube, wherein the conductive needle shaft is configured with a passage along its axis, the side wall of the conductive needle tip is configured with an opening, the opening is communicated with the passage,

one end of the extension tube is connected with the nerve stimulation needle and communicated with the channel, and the other end of the extension tube is provided with a connector matched with the nipple of the injector.

10. A method of using the nerve monitoring system of any one of claims 1-9, comprising,

inserting the conductive needle tip of the nerve stimulating needle near recurrent laryngeal nerve or vagus nerve, attaching the recording electrode to the skin at the thyroid cartilage,

the host is started, the host is utilized to provide a stimulation signal to the nerve stimulation needle, the stimulation signal is released out through the conductive needle tip,

the recording electrode is used for collecting the electromyographic signal and transmitting the electromyographic signal to the host,

and monitoring the electromyographic signals by using a host, and displaying the electromyographic signals on a display screen in an electromyogram manner.

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