Under Direct Endoscopic-Assisted Thoracic Phrenic Nerve Cut Anatomical Study And Clinical Application

OBJECTIVE 1.The study of anatomical relationship of the phrenic nerve provide anatomical basis for under direct vision for the endoscopic-assisted Transthoracic cutting the whole length phrenic nerve transfer for treatment of brachial plexus root injuries.2.To compare new technique with conventional video-assisted thoracoscopic transthoracic phrenic nerve.METHODS 1.The phrenic nerve and its surrounding tissues and organs were anatomy and observation on 10 adult cadavers which is fixed by 10% formalin.2.Clinical application:The surgery under direct endoscopic-assisted thoracic cutting phrenic nerve was summed up in nine patients.RESULTS 1.The pleura covering phrenic nerve in the intrathoracic is more loose and easy separation;The blood supplying of Phrenic nerve mainly comes from the pericardium phrenic artery;Anatomical relationships of the phrenic nerve,pericardial phrenic artery and internal thoracic artery are not constant at the entrance in the thoracic.The location of the end of phrenic nerve which is out of the thoracic by the subclavian second intercostal anterior axillary line is:the left(38.6%±13.1%),the right(52.4%±7.9%).The location of the end of phrenic nerve which is out of the thoracic by supraclavicular incision is: the left(25.9%±11.5%),the right(39.0%±6.9%).The length D between the edge of the third intercostal incision and the phrenic in the pleural top is:the left (14.04±2.17) cm,the right(14.54±1.26) cm;The length E between the edge of the third intercostal incision and the end of phrenic nerve into the muscle is: the left(12.04±6.09) cm,the right(9.99±5.84) cm;The length F between the top of pleural and the top of diaphragmatic is:the left(17.47±5.00) cm,the right(15.71±3.72) cm.The distance from the internal thoracic artery to the sternal edge is:the left(1.38±0.06) cm,the right(1.26±0.16) cm.2.9 cases of brachial plexus root injuries in patients with endoscopic-assisted open cut under Transthoracic shift bridge a total length of the ipsilateral phrenic nerve musculocutaneous nerve surgery complications patients do not appear complications and in good condition after the healing,the first patients can be touched biceps muscle contraction after the surgery 3 months later.CONCLUSIONS 1.The anatomical characteristics of phrenic nerve in the chest cavity is suitable for full-length free.2.The surgery by Endoscopic-assisted thoracic cutting the whole length phrenic nerve transposition is simple and with few complications,the requirements of special equipmentare low,can be carried out as a conventional surgery.