单侧喉返神经损伤神经修复术式探讨

Laryngeal reinnervation for unilateral traumatic recurrent laryngeal nerve injuries

目的 探讨 5种神经修复术治疗单侧喉返神经损伤声带麻痹的疗效。方法 1993年 1月～ 2 0 0 1年 4月治疗外伤性单侧喉返神经损伤声带麻痹 38例 ,病程从损伤即刻至 2年不等。资料完整者 35例 ,其中行神经减压术 8例、颈襻主支喉返神经吻合术 16例、喉返神经端端吻合术 6例、颈襻神经肌蒂埋植术 3例、颈襻神经植入术 2例。手术前后喉镜、嗓音声学参数、肌电图检查等评价手术效果。结果 病程 4个月内神经减压 5例恢复了正常的声带内收及外展功能 ,4个月以内 1例、以上2例及颈襻主支吻合组、喉返神经端端吻合组则未恢复声带运动。但上述 3种术式均能使喉内收肌获有效的再神经支配 ,满意地恢复声带的肌张力、肌体积、声带振动对称性及正常黏膜波 ,声门闭合良好 ,嗓音恢复正常。颈襻神经肌蒂埋植术及颈襻神经植入术均能改善声嘶 ,但无恢复正常病例。结论 ①单侧喉返神经损伤神经修复治疗以神经减压效果最佳 ;②颈襻主支吻合术、喉返神经端端吻合术也能有效地恢复喉的发音功能 ;③喉神经修复术式选择应根据病程、神经损伤程度。

Objective To investigate 5 procedures of laryngeal reinnervation for unilateral vocal cord paralysis induced by traumatic recurrent laryngeal nerve injury Methods 35 cases were selected for our study,all patients had unilateral recurrent laryngeal nerve injury,including 8 for nerve decompression,6 for end to end anastomosis of recurrent laryngeal nerve,16 for main branch of ansa cervicalis anastomosis to recurrent laryngeal nerve,3 for nerve muscular pedicle and 2 for nerve implantation All cases have been subjected to preoperative and postoperative voice recording,acoustic analysis,videolaryngoscopy,strobscopy and electromyography Results It is found the adductory and abductory motion of the vocal cord restored in 5 cases with less than 4 months course who received nerve decompression Although functional motion of vocal cord was not seen in two patients who received nerve decompression with a course longer than 4 months and one less than 4 months,and in all cases who received ansa cervicalis anastomosis and end to end anastomosis of recurrent laryngeal nerve,these procedures resulted in medialization of vocal cord and the mass and tension of the reinnervated vocal cord may become much the same as the contralateral normal vocal cord,thus resuming symmetric vibration of the vocal cords and physiological phonation Nerve muscular pedicle technique and nerve implantation enabled adductory muscles to be reinnervated,thus improving severe hoarseness,but they didn′t restore normal voice Conclusions (1)Nerve decompression seems to be the best procedure in laryngeal reinnervation;(2)Main branch of ansa cervicalis technique raises satisfactory reinnervation of adductor muscles;(3)Selection of the laryngeal reinnervation protocols should depend on the course,severity and type of nerve injury