迷走神经劈开术治疗大鼠声带麻痹的实验研究

Functioning remobilization of the paralyzed vocal cord using the split-vagus nerve procedure in rats

目的:探讨劈开颈段迷走神经中喉返神经支修复大鼠声带麻痹的手术方法和手术效果。方法:首先运用剥离法及乙酰胆碱酯酶组织化学染色方法确定喉返神经支在颈部迷走神经中的位置,将60只SD大鼠被分为3组,实验组为迷走神经劈开术吻合组,切断右侧喉返神经,将其远断段与劈开的颈段迷走神经的喉返支吻合。对照组为喉返神经端端吻合组,切断右侧喉返神经后立即行神经吻合。正常组不做处理。术后3个月利用纤维喉镜及神经肌电图观察声带活动及神经再生情况。结果:喉返神经束位于颈段迷走神经前内侧,单独成束,直径为总干的1/4。术后3个月2种手术方法效果差异无统计学意义(P>0.05)。结论:对喉返神经在迷走神经中准确定位,为手术操作提供了重要的解剖标志。迷走神经劈开术为喉返神经修复术提供一种新的手术方法。

Objective：To locate the recurrent laryngeal nerve fascicles in vagus and investigate the effect of the splilt-vagus nerve procedure to repair the paralyzed vocal cord in rats.Method：The method of dissection and acetylcholinesterase histochemical staining of neural fibers were used to locate the recurrent laryngeal nerve fascicles in vagus.Then 60 SD rats were divided into three groups.In experimental group right recurrent laryngeal nerve were incised and anastomosed to recurrent laryngeal nerve fascicles in vagus by means of the splilt-vagus nerve procedure.In control group right recurrent laryngeal nerve were incised and sutured immediately by means of end-to-end nerve anastomosis.In normal group rats were not treated by any elements.Three months later,rats from each group were examined for vocal cord movement and nerve regeneration by using fibrolaryngscope and nerve electrormyography.Result：The recurrent laryngeal nerve fascicles is in the medial-anterior segment of the vagus and its diameter is about one-fouth as large as the vagus.Three months after operation,the effect of the splilt-vagus nerve procedure had not significant difference compared with the control group（P0.05）.Conclusion：The location of the recurrent laryngeal nerve fascicles in vagus provids important anatomical guideline for surgery.The splilt-vagus nerve procedure has a similiar treatment effect compared with end-to-end nerve anastomosis.This microsurgical technique provides a new method for reparring recurrent laryngeal nerve.