低位直肠癌保留交感神经手术的神经生理学基础——犬模型

Neurophysiological basis of sympathetic nerve-preserving surgery for lower rectal cancer--a canine model.

作者信息

Liang J T, Chien C T, Chang K J, Hsu H C, Chu S H, Lai M K, Wang S M, Chen K M

机构信息

Department of Surgery, National Taiwan University Hospital, Taipei, ROC.

出版信息

Hepatogastroenterology. 1998 Nov-Dec;45(24):2206-14.

PMID:9951896

Abstract

BACKGROUND/AIMS: The relative contribution and interrelated compensation of sympathetic signals among sympathetic components in pelvic plexus remain undefined. This study was designed to investigate the genitourinary function in response to autonomic nerve preservation and severance using a canine model.

METHODOLOGY

Eighteen mongrel dogs were randomly divided into 3 groups which received severance of the hypogastric nerves on either the right side, left side, or on both sides. The hypogastric nerves and sacral sympathetic trunks were electrically stimulated and the contraction pressure of the internal urethral orifice was measured immediately, at 1- and 3-month intervals. The ejaculation function and the length of time required to reach sexual orgasm were evaluated by manual penis-stimulation.

RESULTS

The difference between the left and right sides of the normal hypogastric nerve in contribution to sympathetic signals was insignificant. Compared with the hypogastric nerve, the bilateral sacral sympathetic trunks were functionally trivial in controlling the closure of the internal urethral orifice. The preserved side of the hypogastric nerve compensated for the loss of sympathetic signals of the severed side within 1 month and, thereafter, remained stationary. In contrast, the functional compensation of bilateral sacral sympathetic trunks for the severed bilateral hypogastric nerves was insignificant. When the hypogastric nerve was preserved in one or both sides, all dogs maintained normal antegrade ejaculation. If bilateral hypogastric nerves were severed, 50.0% (3/6) of the dogs lost both emission and ejaculation function; 33.3% (2/6) presented with retrograde ejaculation; and, 16.7% (1/6) presented with combined retrograde ejaculation and reduced antegrade ejaculation. The time required to reach sexual orgasm was not affected by the severance of the hypogastric nerve.

CONCLUSIONS

The normal genitourinary function could be maintained only when at least one side of the hypogastric nerve was preserved.

摘要

背景/目的：盆丛交感神经各组成部分之间交感信号的相对贡献及相互关联的代偿作用尚不清楚。本研究旨在利用犬模型研究自主神经保留和切断后生殖泌尿系统的功能。

方法

18只杂种犬随机分为3组，分别接受右侧、左侧或双侧腹下神经切断术。对腹下神经和骶交感干进行电刺激，并立即、每隔1个月和3个月测量尿道内口的收缩压。通过手动刺激阴茎评估射精功能和达到性高潮所需的时间。

结果

正常腹下神经左右两侧对交感信号的贡献差异不显著。与腹下神经相比，双侧骶交感干在控制尿道内口关闭方面功能微不足道。腹下神经保留侧在1个月内代偿了切断侧交感信号的损失，此后保持稳定。相比之下，双侧骶交感干对切断的双侧腹下神经的功能代偿作用不显著。当一侧或双侧腹下神经保留时，所有犬均保持正常的顺行射精。如果双侧腹下神经切断，50.0%（3/6）的犬丧失射精和发射功能；33.3%（2/6）出现逆行射精；16.7%（1/6）出现逆行射精合并顺行射精减少。达到性高潮所需的时间不受腹下神经切断的影响。