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论著:面神经损伤吻合术手术时机研究
Optimal Timing for Repair of Facial Nerve Trauma
胡炯炯 周梁 马兆鑫
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作者单位:同济大学附属东方医院耳鼻喉科
中文关键字:面神经端端吻合术;手术时机;有髓纤维数/HRP标记神经元;侧支生长
英文关键字:Facial-facial anastomosis;Optimal timing;Myelinated axon per motoneuron ratio;Collateral branches
中文摘要:目的:探讨面神经损伤后最佳的修复时机。方法:以行面神经即时吻合术和延迟吻合术后豚鼠的辣根过氧化物酶(HRP)标记神经元数、有髓纤维数/HRP标记神经元等为观察指标,评价面神经即时吻合和延迟不同时期吻合术后面神经再生的情况。结果:各组指标比较,延迟7 d缝合组和即时缝合组的治疗效果最佳,此2组间差异无统计学意义;延迟60 d缝合组和延迟90 d缝合组治疗效果最差。结论:在无法即时行面神经吻合术的情况下,可在神经断伤后7 d吻合面神经。尽量争取在神经离断伤后60 d内修补损伤的面神经。
英文摘要:Objective: To evaluate the curative effect of immediate nerve suture and delayed nerve suture more comprehensively and more impersonally with longer time course. Methods: All the guinea pigs were randomly assigned to one of eight groups, normal group, group of immediate FFA, group of delayed FFA for 7 days, group of delayed FFA for 14 days, group of delayed FFA for 21 days, group of delayed FFA for 30 days, group of delayed FFA for 60 days, and group of delayed FFA for 90 days by turns. Two months after nerve suture, from observing of HRP-labeled neurons and axons per motoneuron ratio, we evaluate the curative effect of immediate facial-facial anastomosis (FFA) and FFA delayed for 7-90 days objectively. Results: Delayed FFA for 7 days showed equal or even better curative effect than the group of immediate FFA did,the group of delayed FFA for 60days and 90 days showed apparently poorer curative effect than the immediately sutured and other delayed sutured ones did. Conclusions: Repairing facial nerve 7 days after trauma could get as good curative effect as immediate suturing of the nerve. Facial nerve regenerates poorly if it is repaired 60-90 days after trauma. The result is of some value to clinical works, that is, if immediate repair of facial nerve is impossible, repairing it 7 days after trauma is also ideal. Meanwhile, we’d better repair the facial nerve within 60 days.
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