进胸膈神经全长切断后的肺功能变化观察

目的 研究全长膈神经移位术对肺功能的影响。方法 对15例行全长膈神经移位肌皮神经术的全臂丛根性撕脱伤病人的术后肺功能进行回顾性分析。11例共随访42～48个月，4例在随访过程中失访。结果 所有病例术后无呼吸功能障碍，胸部X线片中均出现不同程度的术侧膈肌麻痹和抬高（高1．0～1．5个肋间）。肺功能参数如肺活量、肺活量占预期值的百分比、残气量、肺总量、功能残余量、第1秒用力呼气量在术后1年均恢复到术前水平，但所有病例的最大吸气压值即使在术后4年仍比预期值有明显降低（平均降低20％）。结论 单侧膈神经完全切断后的肺功能参数均在术后1年内逐渐恢复到术前水平。

Pulmonary function follow-up after complete unilateral phrenic nerve transaction

Objective To investigate the status of the pulmonary functions following complete phrenic nerve transfer surgery.Methods Fifteen patients (average age:27.4 years ) with complete brachial plexus palsy underwent the full-length phrenic nerve transfer,and the phrenic nerve was harvested from the thoracic cavity by means of video-assisted-thoracic-surgery and then transferred to the musculocutaneous nerve.Postoperative pulmonary functions were measured and analyzed on a regular basis for 42 to 48 months.Four cases eventually dropped out.Results Although no patient experienced respiratory problems following the surgery,all of the cases showed varying degrees of diaphragmatic paralysis and elevation (for 1.0-1.5 intercostal spaces) at the operated side upon chest X-ray examinations.Pulmonary function parameters,including VC,VC%,RC,TLC,FVC and FEV 1,recovered to the pre- operative levels in one year after the operation,In contrast,the postoperative Pimax value was significantly decreased compared to the predicted values(average decrease 20%)in all of the cases even at 4 years after the surgery. Conclusion In young subjects with healthy lung functions,the unilateral phrenic nerve transection surgery can cause unilateral diaphragmatic paralysis and reduce the inspiratory muscle force.However,most of the pulmonary function parameters gradually recovered to pre-oparative levels within I year.