CAJ | 학술논문

目的对膈神经胸腔内的全程解剖关系进行研究,为胸腔镜辅助直视下经胸切取全长膈神经、移位治疗臂丛神经根性损伤提供解剖学依据.方法选用10%甲醛固定成人尸体标本10具20侧,对膈神经及其周围组织器官进行解剖学观察.临床上对17例臂丛神经损伤患者,于胸腔镜辅助直视下经胸切取膈神经的术式进行总结.结果经锁骨下第二肋间腋前线处出口引出胸腔膈神经远端在上臂的位置比:左侧(38.60±13.10)%,右侧(52.40±7.90)%.经锁骨上切口引出膈神经远端在上臂的位置比:左侧(25.90±11.50)%,右侧(39.00±6.90)%.切口内缘至胸膜顶处膈神经长度(d)与胸膜顶至膈肌顶长度(f)的比值:第三肋间左侧(0.84±0.23),右侧(0.96±0.15);第四肋间左侧(1.02±0.21),右侧(1.08±0.17).切口内缘至膈神经入肌点长度(e)与胸膜顶至膈肌顶长度(f)的比值:第三肋间左侧(0.66±0.15),右侧(0.60±0.21);第四肋间左侧(0.55±0.04),右侧(0.44±0.05).17例臂丛神经根性损伤患者,经胸腔镜辅助直视下经胸切取全长膈神经移位桥接同侧肌皮神经,术后患者均未出现并发症,肱二头肌肌力恢复(肌力M2～M4).结论膈神经在胸腔内的解剖特点适合进行经胸全长游离.胸腔镜辅助直视下经胸切取全长膈神经移位操作简单,安全性高,特殊设备要求低,可作为常规手术开展.
목적 대격신경흉강내적전정해부관계진행연구,위흉강경보조직시하경흉절취전장격신경、이위치료비총신경근성손상제공해부학의거.방법 선용10%갑철고정성인시체표본10구20측,대격신경급기주위조직기관진행해부학관찰.림상상대17례비총신경손상환자,우흉강경보조직시하경흉절취격신경적술식진행총결.결과 경쇄골하제이륵간액전선처출구인출흉강격신경원단재상비적위치비:좌측(38.60±13.10)%,우측(52.40±7.90)%.경쇄골상절구인출격신경원단재상비적위치비:좌측(25.90±11.50)%,우측(39.00±6.90)%.절구내연지흉막정처격신경장도(d)여흉막정지격기정장도(f)적비치:제삼륵간좌측(0.84±0.23),우측(0.96±0.15);제사륵간좌측(1.02±0.21),우측(1.08±0.17).절구내연지격신경입기점장도(e)여흉막정지격기정장도(f)적비치:제삼륵간좌측(0.66±0.15),우측(0.60±0.21);제사륵간좌측(0.55±0.04),우측(0.44±0.05).17례비총신경근성손상환자,경흉강경보조직시하경흉절취전장격신경이위교접동측기피신경,술후환자균미출현병발증,굉이두기기력회복(기력M2～M4).결론 격신경재흉강내적해부특점괄합진행경흉전장유리.흉강경보조직시하경흉절취전장격신경이위조작간단,안전성고,특수설비요구저,가작위상규수술개전.
Objective To study the anatomic relationship of the thoracic phrenic nerve and provide anatomic basis for harvesting whole length phrenic nerve under direct vision using thoracoscope in the treatment of brachial plexus root injuries. Methods The anatomy of thoracic phrenic nerve and its surrounding tissues were observed on 20 sides of 10 adult cadavers which were embalmed by 10% formalin. Video-assisted thoracoscopic transthoracic phrenic nerve harvesting was carried out in the surgical treatment of 17 cases of brachial plexus injuries. The results in these cases were summarized. Results If the cutting end of phrenic nerve was pulled out of the second intercostal space at the anterior axillary line,the ratio of its location in the upper arm was (38.60±13.10)% on the left side and (52.40±7.90)% on the right side. If the cutting end was pulled out of the thoracic outlet,the location ratio in the upper arm was (25.90±11.50)% on the left side and (39.00±6.90)% on the right side. The ratio of phrenic nerve between d (length from medial edge of the incision to the pleural top) and f (length from pleural top to the top of diaphragm) was (0.84±0.23) on the left and (0.96±0.15) on the right at third intercostal space,(1.02±0.21) on the left and (1.08±0.17) on the right at the fourth intercostals space. The ratio of phrenic nerve between e (length from medial edge of the incision to the insertion of diaphragm) and f (length from pleural top to the top of diaphragm) was (0.66±0.15) on the left and (0.60±0.21) on the right at third intercostal space,(0.55±0.04) on the left and (0.44±0.05) on the right at the fourth intercostals space. Endoscopic-assisted transthoracic phrenic nerve harvesting in 17 cases of brachial plexus root injuries obtained full length of the phrenic nerve that could be directly coapted to the muscle branch of the musculocutaneous nerve. No complications were noted.The strength of the biceps underwent good recovery,which was M2 to M4. Conclusion The phrenic nerve in the thoracic cavity is suitable for full-length dissection based on the anatomical characteristics. Endoscope-assisted transthoracic phrenic nerve harvesting is a simple and safe surgery with low requirement of special equipment,and can be carried out as a routine surgery.