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目的 探讨 5种神经修复术治疗单侧喉返神经损伤声带麻痹的疗效。方法 1993年 1月～ 2 0 0 1年 4月治疗外伤性单侧喉返神经损伤声带麻痹 38例 ,病程从损伤即刻至 2年不等。资料完整者 35例 ,其中行神经减压术 8例、颈襻主支喉返神经吻合术 16例、喉返神经端端吻合术 6例、颈襻神经肌蒂埋植术 3例、颈襻神经植入术 2例。手术前后喉镜、嗓音声学参数、肌电图检查等评价手术效果。结果 病程 4个月内神经减压 5例恢复了正常的声带内收及外展功能 ,4个月以内 1例、以上2例及颈襻主支吻合组、喉返神经端端吻合组则未恢复声带运动。但上述 3种术式均能使喉内收肌获有效的再神经支配 ,满意地恢复声带的肌张力、肌体积、声带振动对称性及正常黏膜波 ,声门闭合良好 ,嗓音恢复正常。颈襻神经肌蒂埋植术及颈襻神经植入术均能改善声嘶 ,但无恢复正常病例。结论 ①单侧喉返神经损伤神经修复治疗以神经减压效果最佳 ;②颈襻主支吻合术、喉返神经端端吻合术也能有效地恢复喉的发音功能 ;③喉神经修复术式选择应根据病程、神经损伤程度、类型而定
Objective To investigate the curative effect of vocal cord paralysis of 5 kinds of nerve repair on unilateral recurrent laryngeal nerve injury. Methods From January 1993 to April 2001, 38 cases of vocal cord paralysis were treated by traumatic unilateral recurrent laryngeal nerve injury. The duration of injury ranged from immediately after injury to 2 years. Data were complete in 35 cases, including nerve decompression in 8 cases, 16 cases of recurrent anastomosis of the main branch of the neck, laryngeal nerve end-to-end anastomosis in 6 cases, 3 cases of cervical spine neuromuscular pedicle graft, Nerve implantation in 2 cases. Before and after laryngoscopy, voice acoustics parameters, electromyography and other evaluation of surgical results. Results Within 4 months of course, nerve decompression in 5 cases restored the normal vocal cord adduction and abduction function, within 4 months in 1 case, more than 2 cases and neck ostomy anastomosis group, while the recurrent laryngeal nerve end-group was not Restore vocal movement. However, the above three kinds of surgical procedures can make the laryngeal adductor muscle effectively re-nerve innervation, and satisfactorily restore the vocal cord muscle tone, muscle volume, vocal cord vibration symmetry and normal mucosal waves, glottis closed well, the voice returned to normal. Cervical neuromuscular pedicel implantation and cervical nerve implant can improve hoarseness, but no return to normal cases. Conclusion ① The unilateral recurrent laryngeal nerve injury nerve repair with nerve decompression best; ② neck 襻 anastomosis, recurrent laryngeal nerve end-to-end anastomosis can effectively restore the voice of the larynx; ③ laryngeal nerve repair surgery The choice should be based on course of disease, nerve damage, type and may be