Phrenic Nerve Reconstruction by Intercostal Nerves

在我们的几位患者中，在肺部和纵隔恶性肿瘤的根治性手术中，必须切除膈神经。修复受损的膈神经可维持呼吸功能。我们希望从实验上证实膈神经修复的可能性。14只杂种犬麻醉后行左胸开胸手术。在隔膜上方3 cm处切开左膈神经，行神经外膜修补术。在下肋间间隙上方的表面电极上记录隔膜肌电(EMG-di)。采用最大值以上的膈神经刺激颈部，研究复合肌肉动作电位(M波)。术前和术后每4周至术后12周进行一次横隔膜活动的评估。在8周和12周时，我们证实了重建的膈神经和横隔膜的活动。在统计学上，这些点的传导速度与对照组无差异。

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.