几种神经修复术治疗晚期单侧声带麻痹的比较研究

Delayed Laryngeal Restoration:Comparison of Nerve Suture with Neuromuscular Pedicle Transfer and Nerve Lmplantation

目的 探讨晚期神经修复术以何方法最佳 ,麻痹的喉肌最多可延长至何时神经修复仍能成功。方法 选成年犬 41只 ,分成颈袢主支吻合组 (A)、植入组 (B)、肌蒂组 (C)及去神经对照组 (D)。建立单侧声带麻痹模型 ,A～C组分别在声带麻痹即刻、6、8、10、12及 18个月作 3种相应的神经修复术。术后 6个月作喉镜、电生理学、肌张力、组织化学检查及超微结构观察。结果 A组失神经 10个月以内 ,B、C组 8个月以内作相应神经修复术的动物左声带能恢复不同程度发声内收功能 ,失神经超过上述时间亚组的动物声带固定。电生理学三参数及肌收缩力均以A组恢复最佳 ,而B、C组间无明显差异 ,失神经时间越长 ,各参数恢复程度越差 ,得到组织化学及超微结构检查的证实。结论 晚期神经修复术仍以神经吻合术效果最佳 ,神经植入及肌蒂植入效果无明显差异 ;神经吻合术组去神经 10个月 ,肌蒂及神经植入术组去神经

Objective To determine which method was the best for reinnervating the laryngeal adductor muscles by comparing nerve suture,nerve implantation, and nerve muscular pedicle transfer, as well as the length of time that could elapse after denervation and still allowed for successful reinnervation with the ansa cervicalis.Methods Forty one dogs were divided into four groups to undergo nerve implantation, neuromuscular pedicle transfer, nerve suture or control experiments respectively.Three groups were reinnervated at the time of denervation and six-, eight-, ten-, twelve- and eighteen-month following denervation via nerve implantation or neuromuscular pedicle transfer or nerve suture for restoration of the vocal cord adductors.Results Some recovery of adduction was noted in the cases for nerve suture within ten-month interval and for nerve implantation or neuromuscular pedicle within eight-month interval transfer. Laryngeal electromyography, tension measurement and histochemical studies of the adductor muscles were correlated with the recovery of adduction. Although adduction did not recover after the intervals, the bulk and strength of the adductor muscles were still regained partially. Nerve suture was superior to nerve implantation and nerve muscle pedicle technique in the three procedures of reinnervation. Little difference was noted in the functional recovery, electrophysiological activity and muscle strength between nerve implantation and nerve muscle pedicle transfer.Conclusion Nerve suture was superior to nerve implantation and nerve muscle pedicle technique.Variable return of adduction could be achieved in the cases operated before a 10-interval for reinnervation with NS and an 8-month interval with NI and NMP transfer.