无张力性喉返神经端端吻合修复术的临床解剖学研究  

Clinical anatomic study of end-to-end anastomosis repair of tension-free recurrent laryngeal nerve

作　　者：胡徐意 杨洋[2] 黄文华 Hu Xuyi;Yang Yang;Huang Wenhua(The Third Affiliated Hospital,Southern Medical University,Guangzhou 510630,Guangdong Province,China;School of Basic Medical Sciences,Southern Medical University,Guangzhou 510515,Guangdong Province,China)

机构地区：[1]南方医科大学第三附属医院,广东广州510630 [2]南方医科大学基础医学院,广东广州510515

出　　处：《中国临床解剖学杂志》2024年第6期627-633,共7页Chinese Journal of Clinical Anatomy

摘　　要：目的 进一步了解喉返神经血供来源,确定左右侧喉返神经的可增长范围、发出点及游离终点,为喉返神经端端吻合术提供解剖学依据。方法 利用改良灌注技术对20具女性和10具男性尸体进行血管灌注并解剖喉返神经血供。模拟术式中改变喉返神经走行以及在X2.5倍解剖显微镜下连续游离“迷走喉支”操作,测量操作后喉返神经增长长度。分别在游离迷走神经膜内的“迷走喉支”操作停止处、喉返神经发出点和二者中部各作组织切片,检验分离操作时无神经纤维受损,明确“迷走喉支”游离终点。结果 喉返神经左侧血供主要来自主动脉弓和左颈总动脉,右侧血供主要来自头臂干、右颈总动脉和右锁骨下动脉。改变“迷走喉支”走行后,男性的可增长量结果分别为(11.93±1.23)mm(左)、(3.89±0.37)mm(右);女性的可增长量结果分别为(10.13±0.98)mm(左)、(3.17±0.33)mm(右)。同时,游离“迷走喉支”操作经过组织学检验均无神经损伤。结论 喉返神经血供、改变神经走行后和游离“迷走喉支”后喉返神经增长长度,以及发出点体表投影等数据能够为临床手术修复喉返神经提供依据。Objective To further understand the blood supply source of recurrent laryngeal nerve,determine the growth range,origin point and free end point of left and right recurrent laryngeal nerve,and provide anatomical basis for end-to-end anastomosis of recurrent laryngeal nerve.Methods The blood supply of recurrent laryngeal nerve was dissected in 20 female and 10 male cadavers by modified perfusion technique.In the simulated operation,the shape of recurrent laryngeal nerve was changed and the length of recurrent laryngeal nerve growth was measured after continuous free"vagal branch"operation under X2.5 times anatomical microscope.Tissue sections were taken at the stop of the free"vagolaryngeal branch"operation,the originating point of the recurrent laryngeal nerve and the middle of the two,and no nerve fibers were damaged during the separation operation,and the free end point of the"vagolaryngeal branch"was defined.Results The blood supply to the left side of the recurrent laryngeal nerve was mainly from the aortic arch and the left common carotid artery,and the blood supply to the right side was mainly from the brachiocephalic trunk,the right common carotid artery and the right subclavian artery.The total growth of recurrent laryngeal nerve in male was(11.93±1.23)mm(left)and(3.89±0.37)mm(right),respectively.The total amount of recurrent laryngeal nerve growth in female was(10.13±0.98)mm(left)and(3.17±0.33)mm(right),respectively.At the same time,the free"vagolaryngeal branch"operation was histologically tested without nerve damage.Conclusions The blood supply of recurrent laryngeal nerve,the growth length of recurrent laryngeal nerve after changing nerve course and free"vagal laryngeal branch",and the data of point surface projection can provide the basis for clinical surgical repair of recurrent laryngeal nerve.

关 键 词：喉返神经 甲状腺癌 神经损伤 神经修复术 应用解剖 

分 类 号：R322.8-33[医药卫生—人体解剖和组织胚胎学]