van Lith-Bijl J T, Mahieu H F
Department of Otolaryngology, Head and Neck Surgery, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 1998;255(10):515-20. doi: 10.1007/s004050050110.
Although restoration of laryngeal function after laryngeal transplantation depends on appropriate reinnervation, non-selective reinnervation procedures result in synkinesis and poor function restoration. This study was performed to test the feasibility of selective reinnervation procedures to restore laryngeal function. Three surgical reinnervation procedures were studied each in a group of ten cats: in group 1 a non-selective procedure in which the recurrent laryngeal nerve (RLN) was cut and reanastomosed; in group 2 selective abductor reinnervation was performed with the phrenic nerve; in group 3 selective abductor reinnervation with the phrenic nerve (PN) was combined with selective adductor reinnervation with the ansa cervicalis. Ten weeks after surgical reinnervation abductor and reflex adductor functions were evaluated with videolaryngoscopy and electromyography. Findings demonstrated that non-selective reinnervation not only gave poor abduction during inspiration but even resulted in paradoxical movement during reflex adduction. Selective abductor reinnervation resulted in good abductor function. Selective adductor reinnervation with the ansa cervicalis brought about muscle tonus in the animals studied but no restoration of reflex adduction. Enhanced activity during respiratory distress gave only slight compromise to the abductor function. In all, selective laryngeal reinnervation with the PN and ansa cervicalis produced good restoration of respiratory laryngeal function. However, deglutition following laryngeal motor and sensory reinnervation with protection of the respiratory tract is probably not sufficient, as in the present group of animals no reflex glottic closure was achieved. More research is required.
尽管喉移植后喉功能的恢复取决于适当的神经再支配，但非选择性神经再支配手术会导致联动运动和功能恢复不佳。本研究旨在测试选择性神经再支配手术恢复喉功能的可行性。对三组每组十只猫分别研究了三种手术性神经再支配程序：第1组采用非选择性程序，即切断并重新吻合喉返神经（RLN）；第2组采用膈神经进行选择性外展肌神经再支配；第3组采用膈神经（PN）进行选择性外展肌神经再支配并联合颈袢进行选择性内收肌神经再支配。手术性神经再支配10周后，通过电子喉镜检查和肌电图评估外展肌和反射性内收肌功能。结果表明，非选择性神经再支配不仅在吸气时外展功能不佳，甚至在反射性内收时导致反常运动。选择性外展肌神经再支配导致良好的外展肌功能。颈袢进行选择性内收肌神经再支配使受试动物出现肌肉紧张，但未恢复反射性内收。呼吸窘迫时活动增强对外展肌功能仅有轻微影响。总之，采用膈神经和颈袢进行选择性喉神经再支配可使喉呼吸功能得到良好恢复。然而，如在本组动物中未实现反射性声门关闭一样，在保护呼吸道的情况下进行喉运动和感觉神经再支配后的吞咽功能可能并不充分。还需要更多研究。
