超声刀致喉返神经损伤电生理检测和电镜观察  

Electrophysiology detection and electron microscopy of recurrent laryngeal nerve injuries induced by ultrasonically activated shears

作　　者：周争[1] 王家东[1] 谢明[1] 

机构地区：[1]上海交通大学医学院仁济医院耳鼻咽喉-头颈外科耳鼻咽喉科研究所,上海200001

出　　处：《上海交通大学学报（医学版）》2007年第9期1062-1064,共3页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市高等学校青年科学基金(03BQ41)(Shanghai Science Foundation for the Youthin College;03BQ41)

摘　　要：目的通过电生理检测和电镜观察,探讨超声刀致喉返神经(RLN)损伤的相关因素。方法将15只新西兰兔的30侧喉返神经随机分为正常对照组和实验组(n=6),实验组1、2:距RLN外侧1mm,超声刀持续作用2s和4s;实验组3、4:距RLN外侧3mm,超声刀持续作用2s和4s。各组经神经电图检测即刻损伤时的振幅和潜伏期。对实验组2、3即刻损伤的RLN段以及正常对照组RLN段进行透射电镜对比。结果实验组1、2、4组的振幅和潜伏期均低于对照组(P<0.05);实验组间振幅和潜伏期比较均有显著性差异(P<0.05)。透射电镜观察显示,实验组2的整个髓鞘板层明显肿胀,结构松散、紊乱,轴突皱缩有空泡化,轴浆液化成均质状;实验组3及正常对照组的RLN段电镜下结构正常。结论超声刀可引起RLN损伤,其损伤程度随超声刀与RLN之间距离的缩小以及工作时间的延长而逐步加重。Objective To determine the related factors of recurrent laryngeal nerve（RLN） injuries induced by ultrasonically activated shears（UAS） by electrophysiology detection and electron microscopy. Methods Fifteen New Zealand rabbits （thirty recurrent laryngeal nerves） were randomly divided into 5 groups（ n =6） ： normal （control group） , UAS continued working 2 s 1 mm beside RLN （group 1 ） , 4 s 1 mm beside RLN （ group 2 ） , 2 s 3 mm beside RLN （ group 3） , 4 s 3 mm beside RLN （ group 4）. Electrophysiology of amplitude and latency of the injury were detected in each group. The injured RLN of group 2 and group 3 and RLN of the control group were observed with electron microscopy. Results There were significant differences in amplitude and latency between group 1, 2, 4 and control group, and there were significant differences among group 1, 2, 3 and 4. It was indicated by electron microscopy that in group 2 there were obvious myelin lamellar swelling, structure loose and disorder, axon collapse of a bubble and homogeneous slurry of axoplasm. The normal structure of RLN in group 3 and control group was observed. Conclusion UAS may lead to RLN injury. The severity of injury may increase with the shortening of distance between UAS and RLN and the extension of working time.

关 键 词：超声刀 喉返神经 电生理 电镜 

分 类 号：R653[医药卫生—外科学]