一侧膈神经上根选择性神经再支配环杓后肌的实验研究

Selective Reinnervation of Posterior Cricoarytenoidmuscles by Upper Root of Unilateral Phrenic Cerve

宋伟;李孟;郑宏良;陈世彩;陈东辉;朱敏辉;

1:第二军医大学长海医院耳鼻咽喉头颈外科

2:上海市嘉定区中心医院耳鼻咽喉科

摘要
目的探讨一侧膈神经上根选择性神经再支配环杓后肌的可行性和有效性。方法 8只健康雄性青年Beagle犬作为实验动物,全麻下切断Beagle犬左侧膈神经上根与左侧喉返神经,两断端通过游离神经桥接的方式吻合,并将同侧喉返神经内收肌支切断并植入同侧环杓后肌中;右侧不做任何处理,作为正常对照侧。于手术前、神经修复术后即刻、术后6个月分别行电子喉镜和喉肌电图检查,在最后一次检查后处死动物,取双侧环杓后肌和喉内段喉返神经行组织学检查并与对侧比较。结果术前8只犬的双侧声带运动正常,术后即刻左侧声带固定,术后6个月均恢复了吸气性外展运动。术前8只犬双侧环杓后肌均能记录到自发肌电位,并引出诱发电位;术后即刻左侧环杓后肌呈电静息,未记录到诱发电位;术后6个月均能记录到自发肌电位,并引出诱发电位,而且两种电位幅度分别与术前比较差异均无统计学意义(均为P>0.05)。环杓后肌Masson染色示两侧肌肉纤维相对截面积、胶原纤维相对截面积、肌肉/胶原纤维截面积比差异均无统计学意义(均为P>0.05)。喉内段喉返神经甲苯胺蓝染色后示神经纤维分布较均匀密集,且左右两侧喉返神经有髓神经纤维数量差异无统计学意义(P>0.05)。结论左侧膈神经上根选择性神经再支配环杓后肌能有效避免神经错向再生,恢复声带的生理性外展运动。
关键词
声带麻痹;喉返神经;选择性神经再支配;膈神经
基金项目(Foundation):
国家自然科学基金(81400455)资助
作者
宋伟;李孟;郑宏良;陈世彩;陈东辉;朱敏辉;
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