超声刀致喉返神经损伤不同时期电生理检测和电镜观察的实验研究  

The experimental research for electrophysiology detection and electron microscopic observation on the ultrasonically activated shears injures recurrent laryngeal nerve at different time

作　　者：周争[1] 王家东[1] 李欣[1] 

机构地区：[1]上海交通大学医学院附属仁济医院耳鼻咽喉-头颈外科,上海200001

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第21期990-992,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

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30侧RLN随机分成5组,每组6侧,分别为对照组和实验组1、2、3、4。实验组1:距RLN外侧1mm,超声刀持续作用2s;实验组2:距RLN外侧1mm,超声刀持续作用4s;实验组3:距RLN外侧3mm,超声刀持续作用2s;实验组4:距RLN外侧3mm,超声刀持续作用4s。各组通过神经电图检测损伤即刻和损伤8周后的振幅和潜伏期。实验组2和实验组3损伤即刻和损伤8周后的RLN段,以及正常对照组RLN段,分别进行透射电镜观察。结果:损伤即刻时除实验组3和对照组比较振幅和潜伏期差异无统计学意义,其余各组与对照组比较振幅和潜伏期均差异有统计学意义。损伤8周后各组与对照组比较振幅和潜伏期均差异有统计学意义。透射电镜示损伤即刻实验组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。损伤8周后实验组2的髓鞘板层结构和轴突结构恢复正常。结论:超声刀是新一代手术用切割止血器械,其应用于内镜甲状腺手术中可行且安全,是临床治疗甲状腺肿瘤的一种新选择。Objective：To determine the correlative factors on recurrent laryngeal nerve（RLN）injuries caused by ultrasonically activated shears（UAS）.Method：Fifteen New Zealand rabbits（thirty recurrent laryngeal nerves） were randomly divided into 5groups：group 1 and group 2 are those UAS works 1mm away from RLN for 2s and 4s separately,group 3 and group 4 are those UAS works 3mm away from RLN for 2s and 4s separately,and the other one is control group.Electrophysiology was detected in each group.The RLN injuries of group 2,3 and control group were observed with electron microscope.Result：Significant differences on amplitude and latency were found in all the experimental groups except group 3 when compared to the control group,and between every two experimental groups as well.Histological changes such as obviously swelling myelin lamellar,loosen and disordered structures,bubble-liked axon collapse and liquefaction of axoplasm were only observed in group 2.Conclusion：UAS is a new apparatus for cutting and coagulating in operations,which is safe and reliable to be applied for endoscopic surgery.It will be a new choice for treating thyroid neoplasm.

关 键 词：喉返神经 超声刀 电生理检测 电镜 

分 类 号：R322.85[医药卫生—人体解剖和组织胚胎学]