颈部迷走神经鞘瘤切除术中的神经保护和功能康复

杨柳; 李文; 陈哲; 甘雪琦

doi:10.13201/j.issn.1001-1781.2013.10.004

颈部迷走神经鞘瘤切除术中的神经保护和功能康复

- 1 四川大学华西医院耳鼻咽喉-头颈外科(成都, 610041);
- 2 四川大学华西医院华西口腔医学院

详细信息

通讯作者: 李文, E-mail: church.ent.wc@163.com

中图分类号: R653

收稿日期: 2011-10-08

Protection of vagus nerve during the cervical vagal schwannoma resection and functional rehabilitation

- 1 Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China;
- 2 College of Stamotology, West China Hospital, Sichuan University

More Information

Corresponding author: LI Wen, E-mail: church.ent.wc@163.com

Received Date: 08 October 2011

摘要

摘要: 目的:探讨颈部迷走神经鞘瘤临床解剖特点、术中保护神经连续性及术后功能康复方法。方法:回顾四川大学华西医院耳鼻咽喉头颈外科2002-07-2011-08期间收治的15例颈部迷走神经鞘瘤患者,行保留迷走神经纤维的鞘膜内肿瘤剥离术。术后激素、营养神经药物治疗及发音,吞咽功能锻炼,随访6~24个月。结果:迷走神经鞘瘤患者3例术后2年仍声嘶,肿瘤同侧声带不动,位于旁正中位;2例术后1周肿瘤同侧声带有轻微震动但声嘶不明显,3个月后声带运动恢复正常;10例术后无声嘶,声带运动正常。7例术后饮水呛咳,术后1~3个月逐渐好转;8例无吞咽呛咳。结论:颈部迷走神经鞘瘤术中仔细辨别迷走神经纤维并加以最大限度保护,可以明显减少术后声嘶或吞咽呛咳。对喉上神经的保护也应引起高度重视。
- 迷走神经 /
- 神经鞘瘤 /
- 功能 /
- 康复
Abstract: Objective: To explore the clinical anatomy of vagal schwannoma and the methods to preserve the continuity of vagus nerve during tumor resection and postoperative functional rehabilitation methods of the nerve.Method: To review 15 cases of vagal schwannoma from 2002.07 to 2011.08 treated in the Department of Otolaryngology, West China Hospital. The operative modality was to strip the tumor while keeping the Schwann membrane almost intact so that to protect the nerve fibers as much as possible. postoperative treatment included glucocorticoids, neurotrophic medication, as well as voice and swallowing rehabilitation.Result: Among 15 cases of schwannoma patients, 3 cases(3/15) experienced hoarseness of voice with the ipsilateral vocal cord located at the median position 2 years after operation. 2 cases(2/15) experienced no obvious hoarseness of voice with vocal cords slight vibration when pronouncing and reached normal vocal cord movement 3 months after operation, 10 cases were healed without vocal cord complications, 7 cases (7/15) experienced choking during drinking and the symptom was gradually eliminated 1~3 months thereafter.Conclusion: To carefully discern and preserve the vagal fibers during the operation of vagal schwannoma could eliminate postoperative hoarseness and choking. Protection of superior laryngeal nerve should be also brought to the forefront because it could affect the quality of swallowing and speaking.
- vagus nerve /
- schwannoma /
- function /
- rehabilitation

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