论文部分内容阅读
目的:探讨颈部迷走神经鞘瘤临床解剖特点、术中保护神经连续性及术后功能康复方法。方法:回顾四川大学华西医院耳鼻咽喉头颈外科2002-07-2011-08期间收治的15例颈部迷走神经鞘瘤患者,行保留迷走神经纤维的鞘膜内肿瘤剥离术。术后激素、营养神经药物治疗及发音,吞咽功能锻炼,随访6～24个月。结果:迷走神经鞘瘤患者3例术后2年仍声嘶,肿瘤同侧声带不动,位于旁正中位;2例术后1周肿瘤同侧声带有轻微震动但声嘶不明显,3个月后声带运动恢复正常;10例术后无声嘶,声带运动正常。7例术后饮水呛咳,术后1～3个月逐渐好转;8例无吞咽呛咳。结论:颈部迷走神经鞘瘤术中仔细辨别迷走神经纤维并加以最大限度保护,可以明显减少术后声嘶或吞咽呛咳。对喉上神经的保护也应引起高度重视。
Objective: To investigate the clinical anatomical characteristics of cervical vagus nerve sheath tumors, intraoperative protection of nerve continuity and postoperative functional rehabilitation. Methods: 15 cases of cervical vagus nerve sheath tumors treated in Department of Otorhinolaryngology Head and Neck Surgery, Huaxi Hospital, Sichuan University during 2002-07-2011-08 were retrospectively reviewed. The sheath dissection with vagal nerve fibers was preserved. Postoperative hormones, neurotrophic drugs and pronunciation, swallowing functional exercise, followed up for 6 to 24 months. Results: Three patients with vagus nerve sheath tumors were still hoarse two years after operation, the ipsilateral vocal cord of the tumor was immobilized and was located at the midpoint of the paraventricular. In the other two cases, the ipsilateral vocal cord had slight vibration but hoarseness was not obvious at 3 weeks After vocal cord movement returned to normal; 10 patients were silent hoarseness, vocal cord movement was normal. 7 cases of postoperative cough drinking water, 1 to 3 months after surgery gradually improved; 8 cases without swallowing cough. Conclusion: The vaginal nerve sheath tumors of the neck carefully identify the vagus nerve fibers and maximize protection, can significantly reduce postoperative hoarseness or swallowing cough. The protection of the laryngeal nerve should also be given high priority.