胸腔镜辅助直视下经胸切取膈神经的解剖学研究及临床应用  

Endoscope-assisted transthoracic phrenic nerve harvesting： anatomic study and clinical application

作　　者：白鹤[1] 沙轲[1] 郭立利[1] 谭桢[1] 薛明强[1] 

机构地区：[1]广西医科大学第一附属医院手外科,南宁530027

出　　处：《中华手外科杂志》2011年第3期145-148,共4页Chinese Journal of Hand Surgery

基　　金：广西壮族自治区卫生厅重点课题资助项目（桂卫重200739）

摘　　要：目的对膈神经胸腔内的全程解剖关系进行研究，为胸腔镜辅助直视下经胸切取全长膈神经、移位治疗臂丛神经根性损伤提供解剖学依据。方法选用10％甲醛固定成人尸体标本10具20侧，对膈神经及其周围组织器官进行解剖学观察。临床上对17例臂丛神经损伤患者，于胸腔镜辅助直视下经胸切取膈神经的术式进行总结。结果经锁骨下第二肋间腋前线处出口引出胸腔膈神经远端在上臂的位置比：左侧（38．60±13．10）％，右侧（52．40±7．90）％。经锁骨上切口引出膈神经远端在上臂的位置比：左侧（25．90±11．50）％，右侧（39．00±6．90）％。切口内缘至胸膜顶处膈神经长度（d）与胸膜顶至膈肌顶长度（f）的比值：第三肋间左侧（0．84±0．23），右侧（0．96±0．15）；第四肋间左侧（1．02±0．21），右侧（1．08±0．17）。切口内缘至膈神经人肌点长度（e）与胸膜顶至膈肌顶长度（D的比值：第三肋间左侧（0．66±0．15），右侧（0．60±0．21）；第四肋间左侧（0．55±0．04），右侧（0．44±0．05）。17例臂丛神经根性损伤患者，经胸腔镜辅助直视下经胸切取全长膈神经移位桥接同侧肌皮神经，术后患者均未出现并发症，肱二头肌肌力恢复（肌力M2-M4）。结论膈神经在胸腔内的解剖特点适合进行经胸全长游离。胸腔镜辅助直视下经胸切取全长膈神经移位操作简单，安全性高，特殊设备要求低，可作为常规手术开展。Objective To study the anatomic relationship of the thoracic phrenic nerve and provide anatomic basis for harvesting whole length phrenic nerve under direct vision using thoracoscope in the treatment of broehial plexus root injuries. Methods The anatomy of thoracic plwenic nerve and its surrounding tissues were observed on 20 sides of 10 adult cadavers which were embalmed by 10% formalin. Video-assisted thoracoscopic transthoracic phrenic nerve harvesting was carried out in tile surgical treatment of 17 cases of brachial plexus injuries. The results in these cases were summarized. Results If the cutting end of phrenic nerve was pulled out of the second intercostal space at the anterior axillary line, the ratio of its location in the upper arm was （38.60 ± 13.10）% on the left side and （52.40 ± 7.90 ） % on the right side. If the cutting end was pulled out of the thoracic outlet, the location ratio in the upper arm was （25.90 ± 11.50） % on the left side and （39.00 ± 6.90） % on the right side. The ratio of phrertic nerve between d （length from medial edge of the incision to the pleural top） and f （length from pleura] top to the top of diaphragm） was （0.84 ± 0.23） on the left and （0.96 ± 0.15） on the right at third intercostal space, （1.02 ± 0.21 ） on the left and （1.08 ± 0.17） on the right at the fourth intereestals space. The ratio of phrenic nerve between e （length from medial edge of the incision to the insertion of diaphragrn） and f （length from pleural top to the top of diaphragm） was （0.66 ±0. 15） on the left and （ 0. 60 ± 0.21 ） on the fight at third intercostal space, （0.55 ± 0.04） on the left and （ 0. 44 ＋ 0.05） on the right at the fourth intercestals space. Endoscopic-assisted transthomcie phiertie nerve harvesting in 17 eases of bmehial plexus root injuries obtained full length of the phrenic nerve that could be directly coapted to the muscle branch of the museuloeutaneous nerve. No complications were noted. The strength of the bi

关 键 词：臂丛 膈神经 胸腔镜 

分 类 号：R651.3[医药卫生—外科学]