喉神经修复治疗外伤性声带麻痹的远期疗效分析VIP免费

听力学及言语疾病杂志2006年第14卷第6期419.1ME床研究·喉神经修复治疗外伤性声带麻痹的远期疗效分析陈世彩，郑宏良，周水森，李兆基陈刚，沈小华周义德，王素敏，刘菲，张贤黄益灯’陈东辉，荆建军’【摘要】目的探讨各种神经修复术式治疗外伤性喉返神经损伤的远期疗效。方法外伤性喉返神经损伤致声带麻痹患者153例，单侧138例、双侧15例，病程从损伤即刻至3年不等。行喉返神经减压术31例、颈拌喉返神经吻合术102例、喉返神经端端吻合术9例、月副申经移植及部分病例联合应用神经肌蒂植人术11例。手术前后以喉镜、嗓音评估及声学分析、肌电图检查等评价手术效果。结果①单侧声带麻痹患者:病程3个月内19例,3月以上1例经喉返神经减压术恢复了不同程度的声带内收及外展功能;3个月以内3例、3个月以上4例患者经喉返神经减压及喉返神经端端吻合后均未恢复声带运动;颈拌喉返神经吻合组78例发声时声带突有明显内收运动，24例无明显内收运动;但上述3种术式除喉返神经端端吻合1例、颈拌喉返神经吻合3例外，其余患者发声时声带均处于正中位，声门闭合良好，后联合裂隙不明显，97%(134/138)嗓音恢复正常。②双侧声带麻痹患者:行神经减压4例7侧，有4例5侧恢复运动，均拔除气管套管;行隔神经移植术的11例中，恢复明显吸气性声带外展功能6例6侧，幅度达2一8mm;轻度外展2例2侧，幅度1一2mm，但声门裂隙达6一12mm，此8例均顺利拔管，发声时声带均有一定幅度的内收。2例2侧幅神经移植术后声带仍固定，1例1侧吸气性声带内收，未能拔管。一侧隔神经移植而另一侧肌蒂埋植的4例中，肌蒂埋植侧仅1例声带轻微外展。总拔管率80%(12/15)0隔神经移植手术前后发声无明显变化，神经减压术后发声明显好转。③各种神经修复术的神经再支配得到神经肌电图检查的证实，随访一年以上各项指标无明显退步。结论①喉返神经减压术、颈拌喉返神经吻合术、隔神经移植术能很好地恢复喉的生理功能;②喉神经修复术式的选择应根据病程、神经损伤程度、类型及侧别而定。【关键词】喉返神经;喉肌;声带麻痹;神经再生;神经损伤【中图分类号】R767.6【文献标识码】A【文章编号11006一7299(2006)06一0419一。AStudyoftheEfectofRecurrentLaryngealNerveProsthesisonLaryngealParalysisChenShicai，ZhengHongliang,ZhouShuimiao,etal.(DepartmentofOtorhinolaryngologyHeadandNeckSurgery,ChanghaiHospital，SecondMilitaryMedicalUniversity,Shanghai，200433，China)(Abstract)ObjectiveTostudylong一。enntherapeuticefectofrecurrentlaryngealneurve(RLN)prosthesisonitslesionsinhumans.Methods10153patientswithtraumaticRLNsparalysiswerestudied,including138caseswithunilateralvocalcordparalysis(UVCP)and15caseswithbilateralvocalcordparalysis(BVCP).Thecourseofinjuryvariedfromtheonsetofoccurrenceto3years.In31cases,RLNsweredecompressed.In102cases,RLN-,wereanastomosedtoansacervicalis.In9cases,RLNswereanastomosedendtoend.In11cases,thephrenicnervewasanastomosedtoanteriorbranchofRLNandtheadductorbranchofRLNwascutanditsproximalendwasimplantedintothePCAmuscle.OPretreatmentandpost一treatment,therapeuticeficacywereexamined场laryngoscope,voiceevaluationandvoiceacousticsparameteranalysisandexaminationoflaryngealelectromyo-graphy(LEMG).ResultsThrthesecaseswithUVCP,adductoryandadductorymotionoftheglottiswereobservedin20de-compressedRLNs,including19caseswhosecoursewereshorterthan3monthsand1casewhosecoursewaslongerthan3months.ThevocalcordsmotionwasnotobservedincaseswhoseRLNswereanastomosedendtoend.In102caseswhoseRLNswereanas-tomosedtoansacervicalis,andadductorymotionoftheglotiswasobservedin78cases.97%(134/138)caseshadnormalvoiceback.02InthesecaseswithBVCP,4patientsshowedthemotionoftheglottison5sideswhile4patientshadthenerve一decom-pressedon7sides,achievingsufficientairwaywithoutatracheotomy.Suficientinspiratoryadductorymotionoftheglo...