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【摘 要】 目的：为提高全喉切除术后用发音管发音重建的成功率提供解剖学基础。方法：对40具(男30，女10)成人标本环咽肌进行解剖，观测左右侧喉下神经入喉处与甲状软骨下角的距离、喉下神经和环咽肌的关系。结果：喉下神经入喉点距甲状软骨下角的距离，左侧(5.5±1.4) mm；右侧(5.3±1.3) mm。75%(60侧)喉下神经在环咽肌的下方穿入喉部；25%(20侧)喉下神经在环咽肌纤维之间穿入喉部。结论：本研究对于指导环咽肌切断术，诊治环咽肌失驰缓症，探讨喉下神经和环咽肌的关系等有重要的临床意义。
Applied anatomy of the cricopharynegeus muscle and inferior laryngeal nerve for pronunciation restoration after laryngectomy
Peng Yucheng,Ye Qing,Dang Ruishan,et al.
Department of Otorhinolarynology,Changzheng Hospital,the Second Military Medical University,Shanghai 200003
Objective:To improve the operation of pronunciation restoration after laryngectomy.Methods:The morphology of cricopharynegeus muscle was observed in 40 normal adult cadavers.The distance between the point of the inferior laryngeal nerve entering larynx and the inferior corner of thyroid cartilage were measured.The relationship of inferior laryngeal nerve and cricopharynegeus muscle was observed.Results:The average distance between the point of the inferior laryngeal nerve entering the larynx and the inferior corner of thyroid cartilage was (5.5±1.4)mm on the left,and (5.3±1.3)mm on the right.75%(60 cases) of the inferior laryngeal nerves enter larynx under the cricopharynegeus muscle,while 25% (20 cases) across the cricopharynegeus muscle.Conclusion:The discovery is very significant for the cricophyarnegeus muscle myotomy,diagnosis and treatment of the cricopharynegeus muscle spasm,and research about the relationship of the cricopharynegeus muscle and inferior laryngeal nerve.
Key words Cricopharynegeus muscle Applied amatomy Pronunciation restoration after laryngectomy
全喉切除术后发音管重建发音，近10多年来，在国内外已广泛应用于临床，并取得了较好的效果。Singer等应用发音管时，发现半数以上不能发音者是由于气流引起的环咽肌痉挛所致。国内也有报道10.96%发生术后痉挛性发音障碍。近年来，作者等报道在全喉切除术中同时切断环咽肌或咽下缩肌以提高气管食管发音的成功率。因此为提高发音管发音重建的成功率，有必要对环咽肌的形态和与神经的关系进行研究，以利于指导环咽肌切断术，诊治环咽肌失驰缓症，探讨喉下神经和环咽肌的关系等有重要的临床意义。
1 材料和方法
在40具(男30，女10)正常成人头颈部标本上解剖咽缩肌、环咽肌，分离显露咽下缩肌和环咽肌，显露咽缩肌的纤维。逐层解剖分离，暴露咽下缩肌和环咽肌的起点及食管上段的后壁。显露喉返神经入喉点等。观测左右喉下神经入喉点与甲状软骨下角的距离，在手术显微镜下观测喉返神经与环咽肌的关系等。
2 结果
2.1 测量左右侧喉下神经入喉处与甲状软骨下角的距离
左右侧喉下神经入喉处与甲状软骨下角的距离分别为(5.5±1.4)mm(3.1～10.2 mm)和(5.3±1.3)mm(2.0～9.2 mm)，喉下神经入喉点距甲状软骨下角的平均距离为5.4 mm。
2.2 环咽肌与喉返神经的关系
喉返神经在环咽肌的下方穿入喉部，有75%(60侧，左30，右30)；喉返神经在环咽肌纤维之间穿入喉部，有25%(20侧，左10，右10)。