Department of General and Abdominal Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany.
J Am Coll Surg. 2012 Mar;214(3):306-12. doi: 10.1016/j.jamcollsurg.2011.11.013. Epub 2012 Jan 11.
The aim of this prospective study was to assess internal anal sphincter (IAS) innervation in patients undergoing total mesorectal excision (TME) by intraoperative neuromonitoring (IONM).
Fourteen patients underwent TME. IONM was carried out through pelvic splanchnic nerve stimulation under continuous electromyography of the IAS. Anorectal function was assessed with the digital rectal examination scoring system and a standardized questionnaire.
Nine of 11 patients who underwent low anterior resection had positive IONM results, with stimulation-induced increased IAS electromyographic amplitudes (median 0.23 μV (interquartile range [IQR] 0.05, 0.56) vs median 0.89 μV (IQR 0.64, 1.88), p < 0.001) after TME. The patients with the positive IONM results were continent after stoma closure. Of 2 patients with negative IONM results, 1 had fecal incontinence after closure of the defunctioning stoma and received a permanent sigmoidostomy. In the other patient the defunctioning stoma was deemed permanent due to decreased anal sphincter function. In 3 patients who underwent abdominoperineal excision, IONM assessed denervation of the IAS after performance of the abdominal part.
This study demonstrated that IONM of IAS innervation in rectal cancer patients is feasible and may predict neurogenic fecal incontinence.
本前瞻性研究旨在通过术中神经监测（IONM）评估接受全直肠系膜切除术（TME）的患者的肛门内括约肌（IAS）神经支配。
14 名患者接受了 TME。IONM 通过盆腔内脏神经刺激在 IAS 的连续肌电图下进行。肛门直肠功能通过数字直肠检查评分系统和标准化问卷进行评估。
11 例接受低位前切除术的患者中有 9 例 IONM 结果阳性，TME 后 IAS 肌电图振幅增加（中位数 0.23μV（四分位距 [IQR] 0.05，0.56）与中位数 0.89μV（IQR 0.64，1.88），p <0.001）。IONM 结果阳性的患者在造口关闭后能够控制排便。2 例 IONM 结果阴性的患者中，1 例在关闭预防性造口后出现粪便失禁，接受了永久性乙状结肠造口术。另一位患者由于肛门括约肌功能下降，预防性造口被认为是永久性的。在 3 例接受腹会阴切除术的患者中，在完成腹部手术后，IAS 的 IONM 评估了其去神经支配。
本研究表明，直肠癌患者 IAS 神经支配的 IONM 是可行的，并且可能预测神经源性粪便失禁。
