Leucomethylene Blueによる頭頸部神経染色の試み

STAINING OF NERVES IN THE HEAD AND NECK REGION BY LEUCOMETHYLENE BLUE

　I．はじめに

　頭頸部領域には顔面神経，反回神経，迷走神経，舌下神経をはじめ重要な神経が走行している。したがつてわれわれ耳鼻科医は耳下腺・甲状腺その他の頭頸部手術に際してこれらの神経の損傷や切断には十分な注意を払わねばならないが，時に神経の発見に困難を感ずることがある。そこで神経と周囲組組を識別できる方法があれば術者としても安心して手術を行ないえる。すでに藤田^1）は神経を特異的に染色するといわれるleucomcthylene blueを用いて迷走神経を染色し，胃部手術などに際してその識別に有用であつたと報告している（第1，2図）。われわれは今回このleucomethylene blueを頭頸部領域の手術に際し，神経染色に用いてその有効性について検討したので報告する。

　A staining method of nerves with reduced leucomethylene blue (neurostain®), which is based on the difference of color development between tissues of different oxygen concentration, was attempted for the exhibition of nerves in the operative field in a total of 5 cases comprising 4 clinical cases of the head and neck and 1 case of experimental operation of the neck in a dog.

　The nerves applied by this staining method were the vagus nerve, recurrent laryngeal nerve, facial nerve, hypoglossal nerve and spinal accessory nerve. No noteworthy differences in the stainability were observed among the nerves. Except one case of mixed tumor of the parotid gland in which the facial nerve was staind fairly well, the results of nerve staining were generallydisappointing because the tissues surrounding the nerves were rather strongly stained.

　This failure might be explained by the facts that in the tissues freshly exposed at a surgical field there exist almost no differences in oxygen concentration and also that the peripheral nerves have not so high oxygen reserve.