胸腔镜视下切取膈神经移位治疗臂丛神经损伤的临床应用报告

目的 首创在胸腔镜视下切断膈神经远端移接于肌皮神经的新术式。方法 临床应用５例。在胸腔镜视下于人膈肌近端切断膈神经，游离在胸腔内的膈神经全长。膈神经自锁骨上抽出经皮下引至肌皮神经３例，于锁骨下自第二肋间引起移位于肌皮神经２例。移接于肌皮神经主干２例，移接于肌皮神经肌支３例。首例于术后１１０ｄ，检测肱二头肥肥电图出现再生电位。结论 胸腔镜视下切并游离胸腔内膈神经全长，是膈神经移位术中切取膈神经的最佳

Thoracoscopic harvesting of the phrenic nerve for treatment of brachial plexus avulsion injury: A preliminary report of clinical application

Objective To introduce the new surgical procedure of harvesting the phrenic nerve by thoracoscope. Methods The new procedure was applied in 5 patients with brachial plexus avulsion injury. The phrenic nerve was mobilized to its full length in the thorasic cavity and harvested thoracoscopically, and then transferred to the musculocutaneous nerve. The phrenic nerve was withdrawn out supraclavicularly in 3 cases and subclavicularly from the 2nd intercostal space in 2 cases. It was then coapted with the main trunk of the musculocutaneous nerve in 3 cases and with the motor branch of the musculocutaneous nerve in 2 cases. Results The first patient got the phrenic nerve regeneration evidence by EMG test 110 days after the operation. Conclusions Thoracoscopic harvesting of the phrenic nerve to its full length is the best way in phrenic nerve transfer with minor surgical trauma and faster recovery. Since the phrenic nerve is long enough to be transferred to the median nerve or the ulnar nerve, it might be a hopeful method to restore partial function of the lower trunk after brachial plexus whole root avulsion.