·临床研究·双侧喉返神经损伤神经修复治疗术式探讨陈世彩1郑宏良1周水淼1李兆基1黄益灯1陈刚1张速勤1沈小华1刘锋1崔毅1【摘要】目的探讨三种神经修复术式治疗双侧喉返神经损伤声带麻痹的效果。方法对28例双侧喉返神经损伤声带麻痹患者行喉返神经减压术（8例）、膈神经移植术（11例11侧）、神经肌蒂移植术（9例）。治疗前后以喉镜、嗓音主观评估及嗓音声学分析、喉肌电图检查等评价手术效果，随访1年以上。结果①神经减压术8例13侧有6例10侧声带恢复生理性内收及外展运动，外展幅度2～8mm，声门裂隙6～12mm，顺利拔管；2例双侧声带仍固定无法拔管。②膈神经移植11例11侧中8侧术后恢复声带外展功能，幅度达2～8mm，声门裂隙6～12mm，发声时声带均有一定幅度的内收，此8例均顺利拔管；2侧声带仍固定、1侧吸气时声带反而内收，此3例均未能拔管。③神经肌蒂移植术9例9侧仅1侧吸气时声带轻度外展，声门开大为4mm，发声时声带内移，拔管后不能行较大强度的体力活动。④除6例神经减压术后发声恢复正常外，其余手术前后发声无明显变化。⑤术后12个月膈神经移植、神经减压术侧自发电位波形、诱发电位均明显大于神经肌蒂移植术侧，而前两者差异无统计学意义。结论喉返神经减压术、膈神经移植术较神经肌蒂移植术能更有效地恢复声带吸气性外展运动，神经减压术还能恢复正常发声功能。【关键词】喉返神经；膈神经；外科，手术；神经再生；声带麻痹【中图分类号】【文献标识码】A【文章编号】1006-7299（2006）05-0249-05ComparisonofDifferentProceduresofPosteriorCricoarytenoidMuscIeReinnervationforBiIateraIVocaICordParaIysisChenShicai，ZhengHongIiang，ZhouShuimiao，etaI.（DepartmentofOtorhinoIaryngoIogyHeadandNeckSurgery，ChanghaiHospitaI，SecondMiIitaryMedicaIuniversity，Shanghai，200433，China）【Abstract】ObjectiveTocomparetheresultsof3differentproceduresofposteriorcricoarytenoid（PCA）musclereinner-vationforbilateralvocalcordparalysis（BVCP）inhumans.MethodsThepresentstudyincluded28patients.In8cases，recur-rentlaryngealnerve（RLN）decompressionwasused.In11cases，phrenicnervewasanastomosedtoanteriorbranchofRLNandtheadductorbranchofRLNwascutanditsproximalendwasimplantedintothePCAmuscle.Intheother9cases，nervemuscle-pedicle（NMP）techniquewasused.Therapeuticeffectwasappraisedbylaryngoscopeandstrobe-laryngoscopeandvoiceeval-uationandvoiceacousticsparameteranalysisofpretreatmentandpost-treatment.ResuIts①Abductoryandadductorymotionofthevocalcordsin10sidesof6patientswereobservedinthenerve-decompressed13sidesof8patientsandthevocalcordab-ductoryexcursionvariedfrom1mmto8mm.Theglotticchinkincreasedto6mmto12mmduringinspirationaftersurgery.Therewere6patientsachievingsufficientairwaywithoutatracheotomy，in2patientsvocalcordswereimmovableandtrachea-tubecannotberemovedoff.②Largeandgoodinspiratoryabductorymotionoftheglottisin11sideswereobservedonthereinnervatedsidesbythephrenicnerveandthevocalcordabductoryexcursionvariedfrom1mmto8mm.Theglotticchinkincreasedto6mmto12mmduringinspirationaftersurgery.Therewere8patientsachievingsufficientairwaywithoutatracheotomy，butin2sides，vocalcordswereimmovableandadductorywasobservedin1sidevocalcordduringinspiration.Thesethreepatients’trachea-tubecannotberemovedoff.③In9sidesof9patientswhoreceivedNMPtechnique，onlyslightabductorymotioncouldberecordedin1casewhoachievedenoughairwayandthegoltticchinkwasonly4mm.④Physiologicalphonationwasfoundin6pa-tientsfornerve-decompression，theothersunchanged.⑤BothspontaneousandevokedelectromyographywererecordedonthereinnervatedPCAmusclesforphrenicnervegraftandnervedecompression.Theamplitudeofspontaneousandevokedelectromyo-graphywasnotsi...
