面神经最佳吻合术手术时机选择的电生理研究(1)
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[摘要] 目的 基于电生理反应的不同结果选择面神经损伤后的最佳修复时机。 方法 分别采取即时端端吻合术和延迟端端吻合术处理面神经损伤后的豚鼠，统计不同时间面神经吻合术后口轮匝肌电生理指标——阈刺激强度和单次最大收缩幅度，进而评价面神经即时吻合术和延迟吻合术后面神经再生的情况，确定最佳手术时机。 结果 即时缝合组和延迟7 d缝合组的治疗效果最佳，两组比较差异无统计学意义(P > 0.05)；延迟30 d缝合组和延迟60 d缝合组治疗效果较差，大部分肌纤维已变形或坏死。 结论 在无法即时行面神经吻合术的情况下，可在神经断伤后一周吻合面神经，并且要尽量争取在神经断伤后60 d内修补损伤的面神经。
[关键词] 面神经；面神经端端吻合术；手术时机；电生理
[中图分类号] R651 [文献标识码] A [文章编号] 1673-7210(2012)01(c)-0033-02
Electrophysiological study of the best timing of facial nerve anastomosis surgery
HU Jiongjiong ZHOU Liang MA Zhaoxin
Department of Ear-nose-throat, East Hospital Affiliated to Tongji University, Shanghai 200120, China
[Abstract] Objective To choose the best time of facial nerve repairing based on the results of electrophysiological response to the injury. Methods Immediate end-end anatomosis and delayed end-end anatomosis were adopted respectively in guinea pigs with facial nerve injury. Then the electrophysiological indicators of musculus orbicularis oris at different times after facial nerve anatomosis were calculated, and the indicators were contained with threshold of stimulus intensity and single maximum contraction amplitude. The situation of facial nerve regeneration was evaluated after immediate and delayed end-end anatomosis, in order to determine the optimal time of surgery. Results Therapeutic effects of immediate suture group and 7 d delayed suture group were both good, and there was no significant difference between the two groups (P > 0.05). In the contrary, therapeutic effects of 30 d delayed suture group and 60 d delayed suture group were worse, the major muscle fibers were deformed and necrotic. Conclusion 7 d can be chosen for the repair of facial nerve, in the condition of which can not be done immediately. Facial nerve should be repaired within 60 d after neurectmesis.
[Key words] Facial nerve; Facial-facial anastomosis; Timing of surgery; Electrophysiological
面部神经损伤或断裂将会导致面部肌肉功能的缺失，对患者的生理和心理都会造成负面影响，因此修复神经十分必要。电生理指标是反映神经再生情况的常用指标[1-2]，口轮匝肌是面肌中比较有代表意义的一块肌肉，也是临床上评价术后效果的重要检查部位。因此，本实验切断豚鼠的面神经颊支，制作出豚鼠口轮匝肌失神经支配的模型，然后分为给予即时修复、延迟7 d修复、延迟14 d修复、延迟30 d修复和延迟60 d修复5种处理，选择阈刺激强度和单次最大收缩幅度为观测指标，客观评价不同时间神经吻合术对面神经的修复作用 ......
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