神经端侧吻合术治疗声带麻痹的实验研究

An study on functioning remobilization of the paralyzed vocal cord by latero-terminal neurorrhaphy in rats

目的 :研究神经端侧吻合术治疗声带麻痹的效果及临床应用价值。方法 :6 0只SD大鼠被分为 3组 ,实验组为神经端侧吻合组 ,切断右侧喉返神经 ,将其远断端与右侧膈神经行神经端侧吻合 ,然后切断喉返神经内收支 ,将颈袢的胸骨舌骨肌支与内收支行神经端端吻合 ;对照组为神经端端吻合组 ,切断右侧喉返神经后将其远断端与右侧切断的膈神经近断端行神经端端吻合 ,其他同实验组 ;以上两组均将右侧的喉上神经切断 ,并结扎断端 ,排除环甲肌对声带活动的影响。正常组仅暴露上述神经后不作任何处理。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 :术后 1个月实验组与对照组手术效果差异有显著性意义 (P<0 .0 5 ) ;术后 3个月差异无显著性意义 (P >0 .0 5 )。结论 :神经端侧吻合术手术效果与神经端端吻合术相似 ,并且避免了膈神经的损伤 ,保护了膈肌功能 ,为喉返神经修复术提供了一种新的手术方法。

Objective:To investigate the effect and the clinic value of latero-terminal neurorrhaphy to treat vocal cord paralysis.Method:Sixty SD rats were divided into three groups. In the experimental group, the right recurrent laryngeal nerve(RLN) was incised and anastomosed to the right phren nerve by means of latero-terminal neurorrhaphy. The internal nerve of the right RLN was incised and anastomosed to the right ansa cervicals nerve by end-to-end nerve anastomosis. In control group, the right RLN was incised and sutured to the right phren nerve by end-to-end nerve anastomosis. The internal nerve of the right RLN were incised and anastomosed to the right ansa cervicals nerve by end-to-end nerve anastomosis. In normal group rats, the nerves were only exposed. 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: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 latero-teminal neurorrhaphy has a similar treatment effect compared with end-to-end nerve anastomosis. This microsurgical technique provides a new method for treating vocal cord paralysis.