食管的迷走神经分布特征及其在食管癌外科治疗中的意义

Distribution of vagus nerve in esophagus and its significance on surgical treatment for esophageal cancer

目的:观测全程食管的神经来源与分布特点,为临床行迷走神经保留式食管切除微创术提供解剖学基础。方法:50例防腐固定的成人尸体标本,解剖观测食管各部的神经来源、分支分布特点及其主要分支的横径,并对结果进行统计学处理。结果:①食管颈、胸、腹3部的神经分别来源于迷走神经和交感干的分支,各部分支形式和密度不同;②左、右迷走神经主干沿食管两侧缘下行,与食管壁外膜以疏松结缔组织相连;③迷走神经在胸部的主要食管支和交通支与支气管和膈肌食管裂孔之间具有一定距离;④在胸部,迷走神经分出集中分支前、后的横径,左侧分别为(3.01±0.14)mm和(1.80±0.23)mm;右侧分别为(3.04±0.16)mm和(1.52±0.21)mm。结论:①食管的迷走神经来源于喉返神经、迷走神经主干和颈、胸交感干的分支;②临床上在术中可切断迷走神经的前或后交通支,保留其完整的左、右主干,对改善食管癌切除和食管-胃吻合术后胃肠功能以及预防复发性食管癌可能具有重要的意义。

Objoetive： To explore the origin and distribution of nerves in whole esophagus, and provide anatomic data for esophagectomy with vagus nerve reservation adopting minimally invasive operation. Methods： Gross dissections were performed on 50 cadavers fixed with 10% formaldehyde and perfused with red emulsion. The origins, distribution and transverse diameter of those esophageal nerves were observed and measured, and the data were analyzed with SPSS 10.0 statistical software. Results： ①The nerves of esophagus （cervical, thoracic and abdominal part） originated from the branches of vagus nerve and sympatheric trunk. However, the distribution and density of fibers in each part of esophagus was different; ②The left and right vagi descended along the lateral border of esophagus, being connected with the outer layer of esophageal wall by loose connective tissue;③Main esophageal branches and communicating branches was far from principal bronchus or esophageal hiatus; ④ The transverse diameter of left vagus trunk was about 3.01 ±0.14mm and 1.80 ±0.23mm before and after sending out main branches respectively at the thoracic part, and right 3.04±0.16mm and 1.52±0.2 mm. Conclusions..①The fibers of esophagus originate from the branches of the recurrent nerves, vagus trunk and cervical and thoracic sympatheric trunk; ②To improve the gastrointestinal functions and prevent recurrent esophageal cancer after esophagectomy and gastroesophagostomy, it is important to reserve left and right vagus trunks and cut communicating branches during the operation.