间置神经移植长度对喉返神经再支配结局的影响
The Effect of Interposition Nerve Graft Length on Outcomes of Laryngeal Reinnervation.
文献信息
| PMID | 42833673 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pranati Pillutla |
| 作者单位 | Department of Head and Neck Surgery, University of California, Los Angeles, California, USA. |
| 期刊 | The Laryngoscope |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 基础研究 · 基础／转化 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 评估间置移植长度对喉再支配疗效的影响。
方法： 在体内兔模型中，行单侧喉返神经（RLN）切除，随后立即使用0、2、4和6 cm的间置移植长度进行再吻合（每种长度N=2只动物）。4个月后，采集甲杓肌（TA）和RLN并进行分析。使用苏木精-伊红染色评估肌纤维面积。通过突触后乙酰胆碱受体免疫组化鉴定神经肌肉接头（NMJ），并按形态分类为椒盐卷饼形（正常支配）、碎片形（部分支配）或斑块样（退化）。使用FluoroMyelin脂质荧光染色显示RLN段内的轴突。
结果： 实验侧肌纤维面积趋于减少，但在不同移植长度之间无显著差异。正常对侧肌肉显示100%椒盐卷饼形态。NMJ形态随移植长度增加而逐渐恶化：0 cm移植（62%椒盐卷饼形；38%碎片形；0%斑块样），2 cm（23%；69%；8%），4 cm（15%；54%；31%），6 cm（18%；36%；46%）。远端RLN段轴突计数占近端RLN段轴突的百分比同样随移植长度下降：0 cm移植（平均136%），2 cm（51%），4 cm（19%），6 cm（17%）。
结论： 较长的间置移植与轴突计数减少及NMJ形态日益异常相关。这些发现提示较长的间置移植长度可能降低喉再支配结局。
证据等级： 不适用。
英文摘要
OBJECTIVE: To evaluate the impact of interposition graft lengths on the efficacy of laryngeal reinnervation.
METHODS: In an in vivo rabbit model, unilateral recurrent laryngeal nerve (RLN) resection was performed followed by immediate re-anastomosis using interposition graft lengths of 0, 2, 4, and 6 cm (N = 2 animals per length). After 4 months, thyroarytenoid (TA) muscles and RLNs were harvested and analyzed. Muscle fiber area was assessed using hematoxylin-eosin staining. Neuromuscular junctions (NMJs) were identified by immunohistochemistry for post-synaptic acetylcholine receptors and categorized morphologically as pretzel shape (normally innervated), fragmented (partially innervated), or plaque-like (degenerated). Axons within RLN segments were visualized using FluoroMyelin lipid-fluorescent staining.
RESULTS: Muscle fiber area tended to be decreased on the experimental side but did not differ significantly across graft lengths. Normal contralateral muscles showed 100% pretzel morphology. NMJ morphology progressively worsened with increasing graft length: 0 cm grafts (62% pretzel; 38% fragmented; 0% plaque), 2 cm (23%; 69%; 8%), 4 cm (15%; 54%; 31%), and 6 cm (18%; 36%; 46%). Axon count in the distal RLN segment as a percentage of axons in the proximal RLN segment similarly declined with graft length: 0 cm grafts (mean 136%), 2 cm (51%), 4 cm (19%), and 6 cm (17%).
CONCLUSION: Longer interposition grafts were associated with reduced axonal counts and increasingly abnormal NMJ morphology. These findings suggest longer interposition graft lengths may reduce laryngeal reinnervation outcomes.
LEVEL OF EVIDENCE: n/a.