失神经支配对人喉内收肌和外展肌肌纤维形态的影响  

The influence of denervation on myofiber morphology of the adductor and abductor in patients with recurrent laryngeal nerve paralysis

作　　者：邱晓霞[1,2] 郑宏良[1] 陈世彩[1] 陈东辉[1] 陈剑秋[1] 王伟[1] 夏思文[1] 

机构地区：[1]上海第二军医大学附属长海医院耳鼻咽喉-头颈外科,上海200433 [2]南通大学附属医院耳鼻咽喉-头颈外科,江苏南通226001

出　　处：《临床耳鼻咽喉头颈外科杂志》2011年第24期1125-1130,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨失喉返神经支配对人喉内收肌和外展肌肌纤维形态学的影响规律,为临床晚期喉返神经修复的可行性提供实验依据。方法:内收肌取自环杓侧肌,外展肌取自环杓后肌,人正常环杓侧肌和环杓后肌作为正常对照组(各7例),失神经支配组按喉返神经损伤的不同时限分组:38例环杓后肌中,0.5～1年组7例,>1～2年组10例,>2～3年组8例,>3～6年组8例,>6年组5例;29例环杓侧肌中,0.5～1年组7例,>1～2年组6例,>2～3年组6例,>3～6年组6例,>6年组4例。分别采用苏木精-伊红染色、Masson三色染色,图像分析系统定量分析失喉返神经支配后喉内收肌和外展肌肌纤维截面积和胶原结缔组织截面积的变化。结果:随着失神经时限的延长,肌纤维的截面积逐渐缩小,而胶原纤维截面积逐渐增加。①环杓侧肌失神经0.5～1年组、>1～2年组、>2～3年组间比较差异无统计学意义(P>0.05),失神经>3～6年组肌肉/胶原截面积比下降最为明显,与失神经>2～3年组差异有统计学意义(P<0.05);②环杓后肌正常对照组与失神经0.5～1年组、>1～2年组、>2～3年组、>3～6年组间两两比较,差异均有统计学意义(P<0.05);③环杓侧肌与环杓后肌失神经>3～6年组与>6年组比较,差异均无统计学意义(均P>0.05);④失神经支配1年以后的各组环杓侧肌的肌纤维截面积都明显大于环杓后肌(P<0.05)。结论:失神经支配对喉内肌肌纤维形态学的影响存在差异,以环杓侧肌为代表的喉内收肌肌萎缩速率慢于以环杓后肌为代表的喉外展肌。失神经0.5～1年和>3～6年分别是环杓后肌和环杓侧肌肌纤维形态转变的关键期,提示恢复环杓后肌声带外展功能的神经再支配手术应尽量选择在损伤1年内进行,而恢复环杓侧肌声带内收功能的神经再支配手术可以选择在损伤3年内进行,适时的临床干预可延缓喉肌进一步萎缩纤维化,且此时的喉肌尚具备较好的肌�Objective：To investigate the influence of denervation on myofiber morphology of the adductor and the abductor in patients with recurrent laryngeal nerve（RLN） paralysis and to provide experimental evidence for the clinical feasibility of RLN repair.Method：Adductor muscles were acquired from the lateral cricoarytenoid muscle（LCAM） and abductor muscles from the posterior cricoarytenoid muscle（PCAM）.Normal human PCAM and LCAM are treated as control group（n=7）.Thirty-eight cases of PCAM with damaged RLN were divided into five groups according to the duration of their RLN damage：0.5-1 year（7 cases）,1-2 years（10 cases）,2-3 years（8 cases）,3-6 years（8 cases） and 6 years（5 cases）;twenty-nine cases of LCAM were also divided into five groups： 0.5-1 year（7 cases）,1-2 years（6 cases）,2-3 years（6 cases）,3-6 years（6 cases） and 6 years group（4 cases）.They were all stained with HE and Masson three-color staining,the fiber cross-sectional area of muscle tissue and collagen connective tissue were quantitative analyzed.The changes of myofiber morphology of adductor and abductor muscles after the loss of the RLN were analyzed with image analysis system.Result：The transverse areas of myofibers gradually decreased and those of collagen fibers gradually increased with the prolongation of denervation.①Difference between the denervated groups of LCAM of 0.5-1 year,1-2 years and 2-3 years groups were not significant（P0.05）.Fiber cross-sectional area of 3-6 years group decreased most obviously with significantly difference compared with 2-3 years group（P0.05）;②There were obvious difference between the control group,0.5-1 year group,1-2 years group,2-3 years group and 3-6 years of PCAM（P0.05）;③There was no significant difference between the group of 3-6 years and 6 years of two kinds of laryngeal intrinsic muscle（P0.05）;④Fiber cross-sectional area of each group of the LCAM after 1 year denervation were significantly greater than that of the PCAM under sam

关 键 词：失神经支配 内收肌 外展肌 环杓侧肌 环杓后肌 肌纤维形态 

分 类 号：R767[医药卫生—耳鼻咽喉科]