史其林 顾玉东 200040 上海医科大学附属华山医院手外科 中华手外科杂志 1999 0 15 2


    关键词：内窥镜检查；膈神经；臂丛；研究设计 期刊 zhswkzz 0 基础研究 fur -->


    

【摘要】 目的 研究在胸腔内窥镜镜视下切取尸体膈神经的行径，提供足够长度的膈神经作为动力神经。 方法 新鲜尸体15具，15侧作膈神经在胸腔内走行与毗邻关系的解剖研究；15侧作实验用。 胸腔镜从第5、6肋间锁骨中线外侧插入胸腔，于膈肌上2 cm处切断膈神经后，从锁骨上臂丛切口内拉出膈神经。 结果 膈肌上2 cm处可见膈神经4 ～ 5支分支，距膈肌2 cm以上处切断膈神经，可顺利抽出长度为19 ～ 25 cm的膈神经。 在抽出过程中膈神经无1根断裂。 结论 该术式在尸体实践中操作安全，膈神经长度足以作为修复臂丛神经根性撕脱伤的动力神经。 为临床应用提供了一个切取膈神经的新术式。

A cadaveric study of intrathoracic harvesting of the phrenic nerve under endoscope

SHI Qilin, GU Yudong. Department of Hand Surgery, Huashan Hospital, Shanghai Medical University, Shanghai 200040

【 Abstract 】 Objective To investigate the potential and practicability of providing long donor nerve for neurotization in brachial plexus avulsion injuries by means of endoscopic intrathoracic harvesting of the phrenic nerve. Methods Fifteen fresh cadavers were studied. 15 sides were dissected to observe the course of the phrenic nerve in the thoracic cavity and its relation to the surrounding structures. The other 15 sides were used for endoscopic approach and harvesting of the phrenic nerve. The thoracic endoscope was inserted into the thoracic cavity at the point lateral to the midclavicular line at the 5th to 6th intercostal space. The phrenic nerve was cut off 2 cm proximal to the diaphragm and pulled out from the supraclavicular incision. Results Four to five branches could be seen at the site 2 cm proximal to the diaphragm. If the phrenic nerve was cut off there, a segment 19 cm to 25 cm in length could be harvested without obstacles. In this study, none of the phrenic nerve was ruptured when it was pulled out from the thoracic cavity. Conclusions This method is easy and safe. The study provides a new surgical method to harvest long phrenic nerve for repair of brachial plexus avulsion injuries.

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