干旱区生态环境知识资源中心(Arid): 膈神经替代喉返神经修复治疗双侧声带麻痹

Arid

	膈神经替代喉返神经修复治疗双侧声带麻痹
其他题名	Reinnervation of the posterior cricoarytenoid muscle by the phrenic nerve for bilateral vocal cord paralysis in humans
	郑宏良; 周水淼; 李兆基; 陈世彩; 张速勤; 黄益灯; 温斌; 沈小华; 吴皓; 周蓉珏; 崔毅; 耿丽萍
来源期刊	中华耳鼻咽喉科杂志
ISSN	0412-3948
出版年	2002
卷号	37 期号:3 页码:210-214
中文摘要	目的探讨膈神经喉返神经吻合的内收肌支环杓后肌植入（膈神经手术）治疗双侧喉返神经损伤声带麻痹的有效性、可行性。方法第二军医大学长海医院耳鼻咽喉科1999年8月-2001年7月治疗外伤性双侧喉返神经损伤声带麻痹6例。病程1周-18个月，一侧作膈神经手术，而另一侧作颈袢肌蒂环杓后肌植入术。手术前后电子喉镜、频闪喉镜观察声门大小、声带运动、振动情况，嗓音声学参数分析，喉肌电图检查评价手术效果。结果术后2-3周检查发现4例声门较术前增大2-3mm，但声带固定不动，2例无明显改善。术后6个月5例膈神经修复侧均恢复了较大幅度的吸气性带外展功能，外展幅度可达3-5mm，而肌蒂植入侧仅轻微外展或固定不动，幅度均在1mm以内。此5例均顺利拔管，并能随较大强度的体力活动，1全仍在随访中。术后4个月6例肌电图检查显示膈神经经修复侧自发、诱发电位均明显大于肌蒂植入侧，自发电活动与肋间肌基本同步，而较肌蒂植入侧延迟100-200 ms。声音估价显示3例声嘶术后较术前好转，2例无变化。术后伴年肺功能均恢复正常。结论膈神经喉返神经吻合内收肌支环杓后肌植入术安全可行，较颈袢肌蒂植入术更能有效地恢复声带气性外展运动，值得临床推广应用。
英文摘要	Objective To reestablish the respiratory abduction of the paralyzed vocal cord through reinnervation of the posterior cricoarytenoid(PCA) muscle by the phrenic nerve in humans. Methods In six oases with bilateral recurrent laryngeal nerve paralysis, the phrenic nerve was anastomosed to the anterior branch of recurrent laryngeal nerve, while the adductor branch of recurrent laryngeal nerve was severed and its proximal end was implanted into the PCA muscle belly in one side, for the other side nerve-muscle pedicle technique was used. All cases had been subjected to preoperative and postoperative video laryngoscopy, stroboscopy, electromyography, voice recording and acoustic analysis. Results Among the 6 patients,it is observed in five cases’ phrenic nerve reinnervation side the inspiratory abducent motion evidently recovered, and the abducent range was from 3 to 5 mm, While only slight abductent motion or no motion could be recorded on the other side reinnervated with nerve-muscle pedicle technique, and the vocal cord excursion on this side was Jess than 1 mm in all cases. It is because the glottis is broad enough for the patients to have daily activities without short of breath, so all of them were decannulated postoperatively. The reinnervated PCA muscle by the phrenic nerve showed typical inspiratory high frequency discharge with 100-200 ms delay as compared with the other side, indicating the phrenic motoneuron pattern. No long-term diaphragmatic paralysis and lesion of respiratory function was found. All cases’ voice was not weakened, and no aspiration occurred. Conclusion The phrenic reinnervation is feasible clinically for treating vocal cord paralysis, and it is found to be more effective for restoring inspiratory abducent function than the nerve-muscle pedicle technique.
中文关键词	喉返神经 ; 膈神经 ; 神经再生 ; 声带麻痹
英文关键词	Surgical Procedures Operative recurrent laryngeal nerve phrenic nerve nerve regeneration vocal cord paralysis surgical procedures operative
语种	中文
国家	中国
收录类别	CSCD
WOS类目	OTORHINOLARYNGOLOGY
WOS研究方向	Otorhinolaryngology
CSCD记录号	CSCD:1161947
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/203720
作者单位	第二军医大学长海医院耳鼻咽喉科, 上海 200433, 中国
推荐引用方式 GB/T 7714	郑宏良,周水淼,李兆基,等. 膈神经替代喉返神经修复治疗双侧声带麻痹[J],2002,37(3):210-214.
APA	郑宏良.,周水淼.,李兆基.,陈世彩.,张速勤.,...&耿丽萍.(2002).膈神经替代喉返神经修复治疗双侧声带麻痹.中华耳鼻咽喉科杂志,37(3),210-214.
MLA	郑宏良,et al."膈神经替代喉返神经修复治疗双侧声带麻痹".中华耳鼻咽喉科杂志 37.3(2002):210-214.