双侧颈动脉鞘交感神经切除术联合颈部迷走神经孤立术治疗混合型脑瘫

Bilateral cervical synpathectomy and trapping of cervical vagus nerves for refractory mixed cerebral palsy

目的探讨迷走神经孤立术在颈动脉鞘交感神经切除术治疗难治性混合型脑瘫中的作用。方法回顾性分析682例难治性混合型脑瘫患者的临床资料，57例采用双侧颈动脉鞘交感神经切除术治疗（A组），625例采用双侧颈动脉鞘交感神经切除术联合迷走神经孤立术治疗（B组）。B组85例术中取颈部迷走神经周围结缔组织行抗酪氨酸羟化酶免疫组化染色。对比分析两组间的手术疗效及并发症的差异。结果全部患者术后随访8-134个月，平均54．4个月。A、B组运动功能改善率分别为45．6％和67．4％，生活质量提高率分别为50．9％和73．9％，总显效率分别为77．2％和94．7％，已好转症状复发率分别为18．2％和6．76％。上述各项指标两组间比较均有统计学差异（P〈0．05），两组间术中及术后各种并发症的发生率无统计学差异（P〉0．05）。免疫组化染色显示85例术中所取的颈部迷走神经周围结缔组织的酪氨酸羟化酶表达阳性。结论迷走神经孤立术对提高颈动脉鞘交感神经切除术治疗难治性混合型脑瘫的疗效有重要作用，且不会增加手术并发症；免疫组化证实在颈部迷走神经周围结缔组织中含有交感神经成分。

Objective To study the curative effect of the bilateral cervical sympathetomy and trapping of the cervical vagus nerves on the refractory mixed cerebral palsy. Methods The clinical data of 682 patients with refractory mixed cerebral palsy, of whom, 57 （group A） were treated by the bilateral cervical sympathectomy and 625 （group B） by the bilateral cervical sympathectomy and trapping of the cervical vagus nerves, were analyzed retrospectively. The expression of tyrosine hydroxylase （THA） in the connective tissues around the cervical vagus nerves of 85 patients in group B was determined by immunohistochemical technique. The curative effects and oprative complication were compared between both the groups. Results All the patients were followed-up from 6 to 134 months （mean, 54.4 months）. The improvment rates of improved motor function in group A and B were 45.6% and 67.4% respectively. The improvement rates of life quality in groups A and B were 50.9% and 73.9% respectively and total effective rates in groups A and B were 77.2% and 94.7% respectively. The recurrence rates of the improved symptoms in group A and B were 18.2% and 6.76% respectively. There were significant differences in the improvement rates of mator function and the life quality, the total effective rate and recurrence rates of the improved symptoms during the following-up between both the groups （P〈0.05）. There was insignificant difference in the occurrent rate of the operative complication between both the groups （P〉0.05）. The positive expression of THA was found in the connective tissues around the cervical vagus nerves of 85 patients in group B. Conclusions Trapping of cervical vagus nerves is beneficial to the enhancement of the curative effect of the bilateral cervical sympathectomy on the refractory mixed cerebral palsy without the increase in the operative complications. There are sympathetic nerve fibers shown by THA-positive expression in the connective tissues around the cervical vagus nerves.