本文選題：殘端痛 + 神經(jīng)瘤�。� 參考：《蘇州大學》2014年碩士論文

【摘要】：目的： 探討高頻電刀電切和/或電凝處理周圍神經(jīng)斷端預防殘端痛性神經(jīng)瘤形成的可行性和優(yōu)越性。 方法： 三月齡Sprague-Dawley大鼠56只，隨機分成4組，每組14只。四組大鼠的坐骨神經(jīng)分別接受以下四種手術(shù)方式處理。刀切組：鋒利手術(shù)刀片切除坐骨神經(jīng)約0.5cm；電切組：高頻電刀電切模式切除坐骨神經(jīng)約0.5cm；電切+電凝組：高頻電刀電切模式切除坐骨神經(jīng)約0.5cm，然后電凝模式處理神經(jīng)近斷端；刀切+電凝組：鋒利手術(shù)刀片切除坐骨神經(jīng)約0.5cm，然后采用電凝模式處理神經(jīng)近斷端。術(shù)后定期觀察并評價各組大鼠失神經(jīng)肢體自噬情況、神經(jīng)殘端直徑，采用HE染色方法觀察神經(jīng)殘端纖維再生情況，并且通過免疫組化的方法觀察神經(jīng)生長因子(NGF)在坐骨神經(jīng)殘端的表達情況。 結(jié)果： 1.術(shù)后各組大鼠均未出現(xiàn)死亡，坐骨神經(jīng)切斷后下肢均癱瘓，隨時間延長自噬現(xiàn)象加重，部分患足出現(xiàn)潰瘍。 2．四組中刀切+電凝組大鼠自噬行為評分最低、開始時間晚、重度自噬發(fā)生率最低；電切組自噬評分最高，開始時間早，且重度自噬發(fā)生率最高；其余兩組居中。差異有統(tǒng)計學意義（P0.05）。 3.四組中刀切+電凝組神經(jīng)殘端膨大不明顯，與周圍組織粘連輕；電切組膨大最明顯，且與周圍組織粘連嚴重；其余兩組居中。差異有統(tǒng)計學意義（P0.05）。 4. HE染色光學顯微鏡下可見：刀切+電凝組神經(jīng)纖維排列相對整齊、規(guī)則，結(jié)締組織增生不明顯。其他三組神經(jīng)纖維密集雜亂生長，結(jié)締組織增生明顯，其中電切組最差。 5.免疫組化結(jié)果顯示：術(shù)后四組大鼠神經(jīng)殘端中均有NGF表達，且隨著時間推移，NGF表達均逐漸減弱。術(shù)后3個時間點刀切+電凝組的NGF表達均低于其他三組,電切組均高于其他三組。差異有統(tǒng)計學意義（P0.05）。 結(jié)論： 本實驗證明，，與刀切組、電切組、電切+電凝組相比，采用刀切+電凝法處理神經(jīng)殘端，可以有效抑制殘端痛性神經(jīng)瘤形成。本方法操作簡單，避免了復雜的手術(shù)過程和高昂的手術(shù)費用。
[Abstract]:Purpose :

To investigate the feasibility and superiority of high - frequency electrotome and / or coagulation treatment on the formation of stump pain neuroma .

Method :

In March - old Sprague - Dawley rats , 56 rats were randomly divided into 4 groups .
Electrical cutting group : high - frequency electrotome resection mode to remove the sciatic nerve about 0.5cm ;
Electrical cutting + coagulation group : The sciatic nerve was cut away by high frequency electrotome about 0.5cm , then the nerve proximal end was treated by coagulation mode ;
Knife - cut + electric coagulation group : A sharp surgical blade was used to cut the sciatic nerve about 0.5cm , then the nerve proximal end was treated with the coagulation mode . After operation , the self - tophagocytosis and the diameter of nerve stump were observed and evaluated . The nerve stump fiber regeneration was observed by HE staining method , and the expression of nerve growth factor ( NGF ) in the stump of sciatic nerve was observed by immunohistochemistry .

Results :

1 . No death occurred in the rats after operation , the lower limbs were paralyzed after sciatic nerve transection , the autophagy phenomenon increased with time , and some ulcers occurred in some parts .

2 . The self - tophagy behavior was the lowest in the four groups , and the incidence of severe autophagy was the lowest in the four groups .
The autophagy score was the highest , the start time was early , and the incidence of severe autophagy was the highest .
There was significant difference between the two groups ( P0.05 ) .

3 . The nerve stump of the knife - cut + electric coagulation group in the four groups was not obvious , which was less than that of the surrounding tissue ;
The electric resection group was the most obvious and had serious adhesion to the surrounding tissue ;
There was significant difference between the two groups ( P0.05 ) .

4 . Under the microscope of HE staining , the arrangement of nerve fibers in the knife - cut + electric coagulation group was relatively regular , the rules and connective tissue hyperplasia were not obvious . The other three groups of nerve fibers were dense and disordered , the connective tissue proliferation was obvious , among which the electric resection group was the worst .

5 . The expression of NGF in the nerve stump of the four groups was significantly decreased with time , and the expression of NGF in the three groups was lower than that of the other three groups ( P0.05 ) .

Conclusion :

Compared with the knife - cut group , the electric - cut group and the electro - coagulation group , the present experiment proves that the method can effectively inhibit the formation of the stump pain neuroma compared with the knife - cut group , the electric - cut group and the electric - cut + electric coagulation group , and the method has the advantages of simple operation , avoids complicated surgical procedures and high surgical cost .

【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.4

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