喉返神经在迷走神经颈段定位及临床应用的实验研究

An experimental study on location and clinical application of recurrent laryngeal nerve in vagus nerve

目的 :探讨喉返神经在迷走神经颈段的位置及应用神经端侧吻合术修复喉返神经损伤的效果。方法 :SD大鼠 2 0只 ,采用剥离法 ( 10只 )及乙酰胆碱酯酶组织化学染色法 ( 10只 )确定喉返神经在迷走神经中的位置 ;将 60只SD大鼠分为 3组 :实验组 :切断右侧喉返神经 ,将其远断段与迷走神经颈段喉返束端侧吻合 ;对照组 :切断右侧喉返神经后立即行神经端端吻合。正常组不做处理。术后 1、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 :喉返束位于迷走神经前内侧 ,单独成束 ,直径为总干的 1/ 4。术后 1个月实验组与对照组纤维喉镜及神经肌电图检查结果差异有显著性意义 ( P <0 .0 5 )。术后 3个月两组检查结果差异无显著性意义 (P >0 .0 5 )。结论 :喉返神经在迷走神经中的准确定位 ,为手术操作提供了重要的解剖标志 ;神经端侧吻合术效果与神经端端吻合术相似 。

Objective:To locate the recurrent laryngeal nerve fascicles in vagus and investigate the effect of latero terminal neurorrhaphy to repair recurrent laryngeal nerve.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 latero terminal neurorrhaphy. In control group right recurrent laryngeal were incised and sutured immediately by means of end to end nerve anastomosis. In normal group rats were not treated by any elements. One to three months later, 10 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 front segment of the vagus and it's diameter is about one fourth as large as the vagus. One months after operation, This effect of latero terminal neurorrhaphy had significant difference compared with the control group (P< 0.05 ) .Three months after operation, This effect of latero terminal neurorrhaphy had not significant difference compared with the control group (P> 0.05 ).Conclusion:The location of the recurrent laryngeal nerve fascicles in vagus provids important anatomical guideline for surgery. The latero teminal neurorrhaphy has a similiar treatment effect compared with end to end nerve anastomosis. This microsurgical technique provides a new method for repairing recurrent laryngeal nerve.