舌下神经与面神经吻合术中部位选择的解剖学研究

Anatomic study of the hypoglossal nerve in hypoglossal-facial nerve anastomosis

目的确定舌下神经与面神经吻合的较佳部位及颈袢是否适合与面神经进行吻合。方法(1)在21例防腐固定的成人头颈部标本上,解剖观测舌下神经颈段走行及其毗邻关系。(2)3例新鲜标本取舌下神经近、远段、颈袢及面神经干行组织学检测,测定其神经束数目和横切面积。结果面神经干在出茎乳孔处为单束形式,横切面积为(5.1±0.2,4.6～5.7)mm2;舌下神经近段神经束为(1.6±0.8,1～4)束,神经干横切面积为(7.5±0.7,6.8～8.0)mm2,神经束横切面积为(4.7±0.6,4.1～5.5)mm2;舌下神经远段神经束(3.6±0.5,1～5)束,神经干横切面积为(5.6±0.5,4.9～6.1)mm2,神经束横切面积为(1.6±0.4,0.9～2.2)mm2;颈袢含神经束为(2.4±0.8,1～3)束,神经干横切面积为(1.1±0.7,0.6～2.2)mm2,神经束横切面积为(0.5±0.3,0.3～1.2)mm2。结论颈袢不适合与面神经进行吻合,舌下神经近段具有部分转位与面神经吻合的良好解剖学基础。

Objective To determine the optimal position of hypoglossal nerve in hypoglossal-facial nerve anastomosis and the eligibility of hypoglossal-facial nerve anastomosis with the cervical loop. Methods The cervical course and adjacent structures of the hypoglossal nerve were observed on 21 adult cadavers. The hypoglossal nerve and facial nerve were taken from 3 fresh specimens, and the number of the fasciculus and the cross-sectional area of the nerve were measured. Results The facial nerve trunk were monofascicular with a cross-sectional area of 5.1 ±0.2 （range 4.6-5.7） mm^2. The number of the fasciculus and the cross-sectional areas of the nerve tnmk and the fasciculus were 1.6±0.8 （range 1-4） mm^2, 7.5±0.7 mm2 （range 6.8-8.0） mm^2, and 4.7±0.6 （4.1-5.5） mm^2, respectively, at the proximal segment of the hypoglossal nerve, 3.6±0.5 （1-5） mm^2, 5.6±0.5 （4.9-6.1） mm^2, and 1.6±0.4 （0.9-2.2） mm^2 at the distal segment, and 2.4±0.8 （1-3） mm^2, 1.1±0.7 （0.6-2.2） mm^2, and 0.5±0.3 （0.3-1.2） mm^2 at the cervical loop. Conclusion The cervical loop is inadequate for facial nerve anastomosis and the proximal segment is large enough to allow partial harvesting of the hypoglossal nerve for neurotisation Of the facial nerve.