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目的:探讨颈部迷走神经副节瘤的临床解剖特点、术中保护神经或神经离断后修复的方法。方法:6例颈部迷走神经副节瘤患者,肿瘤均包裹迷走神经干并在手术解剖中离断。在迷走神经离断后行断端吻合术(3例)或颈深神经(2例)、舌下神经(1例)移植术。术后行糖皮质激素、营养神经药物治疗及发声、吞咽功能锻炼。结果:2例副节瘤术后复发患者,术前吞咽呛咳明显,术后吞咽呛咳消失;4例术后吞咽呛咳,6～12个月明显减轻。5例术后声嘶,6～12个月明显改善;1例术后12个月声嘶仍明显。术后3个月纤维喉镜检查,残端吻合术(3例)及舌下神经移植术患者(1例)术侧声带内侧约1/2于发声时有颤动;颈深神经移植者(2例)1例有颤动,1例动度不明显。结论:颈部迷走神经副节瘤术中仔细甄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。迷走神经干离断后的神经断端吻合、颈深神经或舌下神经移植均可能改善声带动度,从而有助于改善声嘶。
Objective: To investigate the clinical anatomical features of the cervical vagus paraganglioma and the method of intraoperative protection of the nerve or the repair of the nerve after it is disarticulated. METHODS: Six patients with cervical vagal paraganglioma were enrolled in the vagus nerve and dissected in surgical anatomy. After the vagotomy was broken, anastomosis (3 cases) or deep cervical nerve (2 cases) and hypoglossal nerve (1 case) were performed. Postoperative glucocorticoids, nutritional neurological treatment and vocalization, swallowing exercise. RESULTS: Two patients with recurrent parabranch tumors had obvious cough and sputum preoperatively and disappeared after swallowing. Four patients had cough and sputum after swallowing, which was relieved in 6-12 months. Five cases of postoperative hoarseness improved significantly from 6 to 12 months; in 1 case, sonar was still apparent at 12 months. Three months after operation, fibrolaryngoscopy, stump anastomosis (3 cases) and hypoglossal nerve transplantation (1 case) quivered about 1/2 of the inner side of vocal cords in the vocal cords; deep neck nerve graft (2) Example: 1 case had tremors, 1 case showed no obvious movement. Conclusions: Careful discrimination of vagal nerve fibers during the operation of the cervical vagus paraganglioma and maximum protection can significantly reduce postoperative hoarseness or swallowing. Anastomosis of the nerves, deep cervical or hypoglossal nerves after vagal nerve transection may all improve the vocal cord movement, which may help improve the sonar.