Phrenic Nerve Reconstruction by Intercostal Nerves

在我们的几个病人中膈神经在恶性肺和纵隔肿瘤的根治性手术中不得不被切除。修复受损膈神经可维持呼吸功能。我们希望通过实验来证实膈神经修复的可能性。14只杂种狗麻醉后进行左开胸手术。在膈上方3cm处解剖左侧膈神经，行外周神经修复术。膈肌肌电图（EMG-di）由下肋间隙表面电极记录。用最大上膈肌刺激颈部观察复合肌动作电位（M波）。术前和术后每4周评估一次膈肌活动，直至术后12周。我们在8周和12周时确认膈神经和膈肌活动的重建。在统计上，这些点的传导速度与控制值没有差异。

In several of our patients the phrenic nerve has had to be resected during radical operations for malignant lung and mediastinal tumors. Repair of the injured phrenic nerve could maintain respiratory function. We wished to confirm the possibility of phrenic nerve repair experimentally. Fourteen mongrel dogs were anesthetized and underwent left thoracotomy. Left phrenic nerve was dissected 3cm above the diaphragm, and epi-perineurial repair was performed. An electromyogram of the diaphragm (EMG-di) was recorded from surface electrodes over the lower intercostal spaces. Compound muscle action potentials (M waves) were studied with supramaximal phrenic stimulation in the neck. Estimation of diaphragmatic activity was performed preoperatively and every 4 weeks until 12 weeks after the operation. We confirmed the reconstruction of the phrenic nerve and diaphragmatic activity at 8 and 12 weeks. Statistically conduction velocity at these points was not different from the control values.