He X, Sun J, Zhang D, Yu Z, Traissac L
Service ORL, No1 Hôpital de l'Université médicale de Kunming, 650032 République Populaire de Chine.
Rev Laryngol Otol Rhinol (Bord). 2005;126(3):131-4.
The aim of this study is to estimate the value of a new surgical procedure in the treatment of the chronic unilateral laryngeal paralysis.
The recurrent laryngeal nerve of the left side of the dog was totally cut and served as a model of unilateral laryngeal paralysis at the first step of the research. The adductor and abductor branches of the recurrent laryngeal nerve were then, selected and cut. Afterwards, they were micro-sutured respectively with one branch of ansa cervicalis and phrenic nerve immediately (group 1) and 4 months later (group 2). Six months after this reinnervation, the laryngeal physiologic function of the lateral crico-arytenoid muscle (LCA) and the posterior crico-arytenoid muscle (PCA) have been checked by the methods of electromyography (EMG) and direct laryngoscopy. All the data have been analysed by the statistic methods.
Among all the data of EMG, only the wave amplitude of action potential of the LCA muscle of the group 2 was diminished (p < 0.05). Under the direct laryngoscopy, the adductor movement of the left vocal cord of the group 2 was also lightly reduced. But the adductor and abductor movements of the left vocal cord were synchronous with the mouvements of the right vocal cord.
Though the result of nervous reinnervation of a four month's laryngeal paralysis was not so good by comparison with that of an immediate reinnervation, this surgical procedure can however on the clinical point of view, reach a satisfactory level. The duration maximum of the reinnervation operation after laryngeal paralysis, is, at the present, not clear. It is necessary for us to make further studies.
本研究旨在评估一种新的外科手术治疗慢性单侧喉麻痹的价值。
在研究的第一步，将犬左侧喉返神经完全切断，作为单侧喉麻痹的模型。然后，选择并切断喉返神经的内收肌支和外展肌支。之后，分别立即（第1组）和4个月后（第2组）将它们与颈袢的一个分支和膈神经进行显微缝合。在这种神经再支配6个月后，通过肌电图（EMG）和直接喉镜检查方法检查环杓侧肌（LCA）和环杓后肌（PCA）的喉生理功能。所有数据均采用统计学方法进行分析。
在所有EMG数据中，仅第2组LCA肌动作电位的波幅降低（p<0.05）。在直接喉镜检查下，第2组左侧声带的内收运动也略有减弱。但左侧声带的内收和外展运动与右侧声带的运动同步。
虽然与立即进行神经再支配相比，4个月喉麻痹的神经再支配结果不太理想，但从临床角度来看，这种外科手术仍能达到令人满意的水平。目前，喉麻痹后神经再支配手术的最长持续时间尚不清楚。我们有必要进一步研究。
