几丁质管桥接喉返神经缺损的实验研究

为在恢复神经再支配手术治疗喉返神经损伤所致的喉麻痹中,探索一种新的可避免神经误向支配的方法,采用非神经生物材料几了质管,桥接狗喉返神经干的缺损,并用自体神经移植作为对照组.术后5个月,组织学、组织化学和电生理等检测,显示两组动物的喉内肌皆获得神经再支配.实验组术侧声带较明显恢复了和健侧一致的内收和外展运动,甲杓肌(Thyroarytenoid,TAM)和环杓后肌(Posterior cricoarytenoid musdes,PCAM)也分别出现了相应的生理性自发肌电;对照组的术侧声带无明显的运动,TAM和PCAM则在呼气期和吸气期均出现不规则的持续密集自发肌电.提示几丁质桥接喉返神经干缺损可使其定向性再生,选择性支配喉内肌.

Selective Reinnervation of the Divided Recurrent Laryngeal Nerve Through Chitin Tube in Canines

This study attempted to pursue a new medium in the reinnervation and to reestablish physiologic vocal cord motion,rather than synkinesis.Eight dogs were divided into two groups randomly in the experiment. The right recurrent laryngeal nerve defects(5 mm) were sheathed with chitin tube in four dogs and nerve auto graft in other dogs as control.Five months later,regenerative morphology, histological analysis and electrophysiologic graphs showed that chitin tube had guided the regenerated axons across the defect region;moreover,functional appearances and spontaneous electromyography of the thyroarytenoid muscle and posterior cricoarytenoid muscle proved that physiologic adduction and abduction of the vocal cords had recovered to a great extent. As for the control,although the paralysed laryngeal muscles obtained reinnervation,no significant motion of vocal cords was observed. This study demonstrated that selective reinnervation could be achieved from the divided recurrent laryngeal nerves and misdirected regeneration of axons could be minimized,physiologic motion of vocal cords will be restored under this technique.