Experimental And Clinical Study On Freezing Phrenic Nerves For The Patients Of Lobectomy

Objective:(1)To explore the pathological change including damage and repair process of nerve in different freezing time at same temperament(-65℃);(2)To make sure the safety of Freezing phrenic nerves.Methods:The freezing temperature was -65℃.The experiment animals were goats. In the experiment we opened the right thorax through the eighth intercostal incision.After separating phrenic nerve from outside of inferior vena cava,we froze phrenic nerve at different time including 30,60,90 and 120 seconds,then made a maker.After 60 days,we opened the thorax and froze phrenic nerve at different time again.Then we got material and carried on the pathology check.Results:We observed on operative day that freezing nerves at 90 and 120 seconds presented clear degeneration,necrosis of the nerve fiber.However the freezing nerves at 30 and 60 seconds presented a little edema of the neurilemmas,axons and myelin sheaths.After 60 days,all nerves had no obvious differentiation than normal with naked eye.The basic pathological changes of all nerves became normal with microscope,but all still had hyperplasia changes.Conclusions:(1)The damage of nerve progressed along with freezing time at -65℃.(2)The freezing nerves presented early obvious damage at no less than 90 seconds.(3)It proved that Freezing phrenic nerves was safe by the repair of Freezing nerves at 120 seconds at -65℃. Objective:(1)make out the results and effects after freezing phrenic nerves on patients of lobectomy.(2)find out the optimum freezing time by studying the effects of different time at -65℃.Methods:50 patients of lobectomy were randomly entered into 5 groups:(1)control group;(2)30 seconds group;(3)60 seconds group;(4)90 seconds group;(5)120 seconds group.After operation we noted the patients' cardiotach,blood pressure,SaO₂,breath rate,thoracic drainage,time of pulling out drainage tube and VAS about referred pain of scapular region,after pulling out the intrathoracic drain tube,the routine chest normal X ray film and chest ultrasonic inspection were processed and the post-operation remnant cavity were observed.The chest normal fluoroscopy was inspected in 60 days after operation in order to observe the motion information of trouble side diaphragmatic muscle.Results:The heart rate,blood pressure,saturation of blood oxygen and breathing rate of each group have no difference.The chest fluid,time of pulling out intrathoracic drain tube and VAS about referred pain of scapular region of 90s and 120s freezing groups were obviously lower than the control group.However, that of 30s and 60s groups does not significantly different from the control group and that of 90s group does not different from the 120s group.The remnant cavity sizes were the largest in the control group and 30s groups,also they have the most fluidity,and one case in the control group has been taken punctuation.The remnant cavity sizes were larger in the 60s group and that of 90s and 120s freezing groups were small and didn't need special treatment.The diaphragmatic muscle's movement of each group were fine after 2 months of operation.Conclusions:(1)The freezing phrenic nerves can effectively reduce the chest fluid, the post-operation remnant cavity and the time of pulling out intrathoracic drain tube.(2)The freezing phrenic nerves can reduce the pain of referred pain of scapular region.(3)The best freezing time should be 90s.(4)The freezing phrenic nerves does not influence the respiration function,and should be advance the clinic research and application.