颈神经丛的组织化学研究

A Histochemical Study on Cervical Plexus

目的 拟确定颈丛及其分支是否含有运动神经轴突 ,从而探讨根治性颈清扫术后肩 (胛 )综合征的发生机制 ,并提出改良颈清扫术术式 ,以保存术后正常的肩功能。方法 通过AchE组织化学染色法对颈丛C2～C4及其相关分支的神经纤维进行鉴定。结果 颈丛C2～C4均含运动神经轴突。 6 6 .6 7%的病例至少有 1根以上。颈丛近根部AchE染色呈阳性 ,4 5 .4 5 %颈丛斜方肌支含运动神经轴突 ,颈丛肩胛提肌支及头夹肌的分支均含有运动纤维。结论 颈丛可作为斜方肌的一个运动神经支配来源。颈清扫术中保留颈丛到斜方肌的支配和行颈丛肩胛提肌支副神经移位吻合可较好地恢复术后斜方肌的功能。

Objective The cervical plexus controls the trapezium muscle dominantly innervated by the accessory nerve, but whether the cervical plexus contains motor fibers has not been verified. The objective of this study is to explain the mechanisms of shoulder arm syndrome due to radical neck dissection through identification of cervical plexus and its branches, so as to modify the traditional neck dissection and preserve the normal shoulder function. Methods The ventral rami of cervical nerves were dissected near their roots among 30 cases of radical neck dissection. The branches of the cervical plexus to the trapezium muscle, scapular levator and capital splenius muscles were also sampled. The sampled nerves were promptly studied by histochemical staining for acetylcholinesterase activity. Results 66.67% cervical plexus contained motor axons. Most of the motor fibers were found in the C3 and C4 ventral rami. All the branches of the cervical plexus to the scapular levator muscle and capital splenius muscle contained motor fibers, but motor fibers existed only in 45.45% branches to the trapezius muscle. Conclusion Based on these histochemical findings and our earlier studies, the cervical plexus should be considered to be a significant source of motor innervation to the trapezium muscle. It was suggested that some modified styles should be taken into consideration during neck dissection to improve shoulder function and survival quality without compromising cancer clearance, such as preservation of the branches from cervical plexus to trapezium muscle (C3, C4) and anastomosis of distal accessory nerve end to the end of the branch from cervical plexus to scapular levator muscle.