高频电刀预防神经瘤性残端痛的实验研究  

An experiment study of the effect of high frequency electrotome on preventing the formation of painful neuroma

作　　者：周聚普[1] 苏冠龙[2] 江波[1] 王培吉[1] 

机构地区：[1]苏州大学附属第二医院手足外科,江苏215004 [2]太仓市第一人民医院

出　　处：《中华手外科杂志》2016年第4期296-299,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨高频电刀电切和（或）电凝处理周围神经断端预防神经瘤形成的可行性和实用性，以进一步预防残端痛。方法取3个月月龄的sD大鼠56只，随机分为4组，每组14只。4组大鼠的坐骨神经分别接受刀切、电切、电切＋电凝、刀切＋电凝等不同处理。术后定期观察并评价各组大鼠失神经肢体自噬晴况、神经残端直径，组织学观察神经残端纤维再生情况，并通过免疫组化观察神经生长因子在坐骨神经残端的表达情况。结果刀切＋电凝组大鼠自噬行为评分最低，开始时间晚，重度自噬发生率最低；电切组自噬行为评分最高，开始时间早，且重度自噬发生率最高，差异均有统计学意义（P〈0．05）。刀切＋电凝组神经残端膨大不明显，与周围组织粘连较轻；电切组膨大最明显，与周围组织粘连严重，差异均有统计学意义（P〈0．05）。免疫组化结果显示，术后4组大鼠神经残端中均有神经生长因子表达，刀切＋电凝组均低于其他3组，电切组均高于其他3组，差异有统计学意义（P〈0．05）。结论实验证明，与刀切组、电切组、电切＋电凝组相比，采用刀切＋电凝法处理神经残端，可以有效抑制残端痛性神经瘤形成。该方法操作简单，避免了复杂的手术过程和高昂的手术费用。Objective To investigate the feasibility and practicability of high frequency electrotome cutting and （or） coagulation of nerve stumps in preventing painful neuroina formation. Methods Fifty-six 3- month-old Sprague-Dawley rats were randomly divided into four groups with 14 rats each. Depending on group assigmnent, the sciatic nerve was cut by a blade, by electric cutting with a high frequency electmtome, by electric cutting and coagulation with the electmtome, by a blade and electric coagulation with the electrotome. Postoperative observation and evaluations included the incidence of autotomy, the diameter of the nerve stump, nerve fiber regeneration and orientation at the nerve stump, and immunohistochemical staining of nerve growth factor （NGF） expression at the sciatic nerve stump. Results The blade and electric coagulation group had the lowest autotomy level, the latest autotomy onset, and the lowest incidence of severe autotomy. The nerve stump did not show obvious enlargement, neither was it adhered to the surrounding tissue. On the contrary the electric cutting group had the highest autotomy level, the shortest average onset time of autotomy and the highest incidence of severe autotomy. There was obvious neuroma formation at the nerve stump which was tightly adhered to the surrounding tissue. The differences between these two groups were significant （P 〈 0. 05 ）. Immunohistochemical staining demonstrated NGF expression in the nerve stumps of rats in all 4 groups. The expression level was the lowest in the blade and electric coagulation group and highest in the electric cutting group. Conclusion Cutting nerve with a sharp blade and coagulating it with a high frequency electrotome is an effective method to prevent the formation of painful neuroma. This method is not only simple but also cost efficient.

关 键 词：神经瘤 电凝术 残端痛 动物实验 

分 类 号：R658[医药卫生—外科学]