Pelvic autonomic nerve preservation with real-time monitoring during laparoscopic total mesorectal excision for retal cancer

doi:10.3969/j.issn.1009-976X.2022.05.006

Abstract

Abstract: Objective To study pelvic autonomic nerve preservation using real-time minitoring during laparoscopic total mesorectal excison for rectal cancer. Methods We prospectively investegated 11 cases of rectal cancer patients undergoing laparoscopic TME during January 2018 and December 2020. PANP procedure was done using real-time monitoring. The urinary and anorectal function and the correlation between the electromyography and postoperative function were analysed. Results All patients were succsessfully perfomed PANP with real-time monitoring, and all get positive results. The postoperative urinary and anorectal functions of all patients were complete. The correlation between the electromyography and postoperative function was very good（r=1.0）. Conclusion Pelvic autonomic nerve preservation using real-time minitoring during laparoscopic total mesorectal excison for rectal cancer is safe and effective and the positive electromyography indicates a complete urinary and anoretal function.

Key words: real-time minitoring, total mesorectal exicion, pelvic autonomic nerve preservation

摘要： 目的探讨实时神经监测在腹腔镜直肠癌全直肠系膜切除术中盆腔自主神经丛保护的应用。方法选取2017年1月至2020年12月非急诊收治的直肠癌患者,共11例。所有患者均进行腹腔镜直肠癌全直肠系膜切除术,术中使用实时神经监测进行盆腔自主神经丛保护,术后评估排尿、肛管直肠功能,并分析两者相关性。结果所有患者均成功进行术中实时神经监测,神经监测电生理结果均为阳性,术后第6月进行功能评估,均未发生排尿、肛管直肠功能不全,两者相关性良好（r=1.0）。结论实时神经监测在腹腔镜直肠癌全直肠系膜切除术中盆腔自主神经丛保护的应用安全、有效,结果阳性提示术后排尿、肛管直肠功能完好。

关键词: 实时神经监测, 全直肠系膜切除术, 盆腔自主神经丛保护

CLC Number:

R735.3+7

TAN Ming-hua, DU Guo-neng, LIAO Jian-nan, XIE Hong, OU Xiao-wei. Pelvic autonomic nerve preservation with real-time monitoring during laparoscopic total mesorectal excision for retal cancer[J]. Lingnan Modern Clinics In Surgery, 2022, 22(05): 463-465.

谭明华, 杜国能, 廖健南, 谢宏, 区小卫. 实时神经监测在腹腔镜直肠癌全直肠系膜切除术中盆腔自主神经丛保护的应用[J]. 岭南现代临床外科, 2022, 22(05): 463-465.

References

[1] Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment[J]. Nat Rev Urol, 2011, 8(1):51-57.
[2] Shiraishi T, Ito M, Sasaki T, et al.Association between urinary function and resected pattern of the autonomic nerve system after transanal total mesorectal excision for rectal cancer[J]. Colorectal Dis, 2021, 23(2): 405-414.
[3] Kim HS, Kang JH, Yang SY, et al.Long-term voiding and sexual function in male patients after robotic total mesorectal excision with autonomic nerve preservation for rectal cancer: a cross-sectional study[J]. Surg Laparosc Endosc Percutan Tech, 2020, 30(2): 137-143.
[4] Hanna NN, Guillem J, Dosoretz A, et al.Intraoperative parasympathetic nerve stimulation with tumescence monitoring during total mesorectal excision for rectal cancer[J]. J Am Coll Surg, 2002, 195(4): 506-512.
[5] Schiemer JF, Zimniak L, Grimminger P, et al.Robot-guided neuromapping during nerve-sparing taTME for low rectal cancer[J]. Int J Colorectal Dis, 2018, 33(12): 1803-1805.
[6] Kneist W, Heintz A, Junginger T.Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer[J]. J Am Coll Surg, 2004, 198(1): 59-66.
[7] Takenaka A, Tewari A, Hara R, et al.Pelvic autonomic nerve mapping around the prostate by intraoperative electrical stimulation with simultaneous measurement of intracavernous and intraurethral pressure[J]. J Urol, 2007, 177(1): 225-229.
[8] Nakanishi R, Yamaguchi T, Akiyoshi T, et al.Laparoscopic and robotic lateral lymph node dissection for rectal cancer[J]. Surg Today, 2020, 50(3): 209-216.
[9] Haim N, Wexner SD.Rectal cancer-associated urinary dysfunction: a review[J]. Curr Bladder Dysfunct Rep, 2015, 10: 118-124.
[10] Lange MM, Martz JE, Ramdeen B, et al.Long-term results of rectal cancer surgery with a systematical operative approach[J]. Ann Surg Oncol, 2013, 20(6): 1806-1815.
[11] Costanzi A, Rigamonti L, Mari GM, et al.A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer[J]. Surg Endosc, 2015, 29(7): 1721-1728.
[12] Kneist W, Kauff DW, Rahimi Nedjat RK, et al.Intraoperative pelvic nerve stimulation performed under continuous electromy- ography of the internal anal sphincter[J]. Int J Colorectal Dis, 2010, 25(11): 1325-1331.
[13] Kauff DW, Moszkowski T, Wegner C, et al.Transcutaneous sacral nerve stimulation for intraoperative verification of internal anal sphincter innervation[J]. Neurogastroenterol Motil, 2017, 29(12).
[14] Kneist W, Kauff DW, Gockel I, et al.Total mesorectal excision with intraoperative assessment of internal anal sphincter innervation provides new insights into neurogenic incontinence[J]. J Am Coll Surg, 2012, 214(3): 306-312.
[15] 杜国能,陈晓意,肖玉根,等.新型适配器用于术中喉返神经监测165例效果观察[J].中国实用外科杂志,2017, 37(10):112-113.
[16] 肖玉根,程若川,陈晓意,等.新型适配器在术中喉返神经功能持续监测中的临床应用:附329例报告[J].中国普通外科杂志,2015, 27(5):647-650.