膈神经与面神经吻合的解剖学研究

目的:探讨膈神经移位与面神经干吻合的解剖学基础。方法:解剖11具22侧成年尸体头颈部,观察并测量:①膈神经根与面神经总干腮腺区分叉处之间的距离;②膈神经干在颈部可利用长度;③面神经总干腮腺区分叉处游离至水平半规管下缘可利用长度,面神经总干腮腺区分叉处游离至水平半规管下缘较游离至茎乳孔处增加的面神经干可利用长度;④面神经总干腮腺区分叉处至水平半规管下方切断处膈神经干及面神经干神经移位后并列放置重合长度。结果:①膈神经根与面神经总干腮腺区分叉处之间的距离为(7.2±0.9)cm。②膈神经起点至锁骨下静脉上缘平面为(7.2±1.6)cm。③面神经总干腮腺区分叉处至水平半规管下方切断处的长度2.7~3.5 cm,较面神经干自茎乳孔下方切断增加1.0~1.5 cm。④神经移位后重合长度为0.4~1.8 cm。结论:在锁骨下静脉上缘平面切断20侧标本膈神经可与自乳突内切取的面神经干无张力吻合,两侧膈神经不能与自乳突内切取的面神经干无张力吻合。

Applied anatomic study on the repair of the facial nerve defect by the anastomosis of the facial nerve with the phrenic nerve

OBJECTIVE: To explore of the anatomic basis of the anastomosis of the facial nerve with the phrenic nerve. METHOD: Bilateral microsurgical dissection was performed on eleven human cadavers fixed with formalin. The following length data were measured with calipers: the distance between the bifurcation of the facial nerve trunk and the phrenic nerve root, the useful length of the facial nerve trunk and the phrenic nerve, and the distance between the overlapped nerve ends. RESULT: The length from the root of the the phrenic nerve to the level of the subclavian vein was (7.2 +/- 1.6) cm. The length from the root of the phrenic nerve to the bifurcation of the facial nerve trunk was (7.23 +/- 0.9) cm. The length from the bifurcation of the facial nerve trunk to the level below the horizontal semicircular canal was 2.7-3.5 cm, 1.0-1.5 cm longer than that cut below the level of the stylomastoid foramen. The cutting nerve ends were placed side by side. The distance between the overlapped nerve ends was 0.4-1.8 cm. CONCLUSION: In 20 specimens the tension-free anastomosis of the facial nerve with the phrenic nerve that cut in the subclavian vein level can be achieved, in 2 specimens the tension-free anastomosis can not be achieved.