Current research status on pelvic autonomic nerve monitoring in rectal cancer surgery / 中华胃肠外科杂志

Rectal cancer is a common malignant tumor of the digestive tract, and surgery is the main treatment strategy. Disorders of bowel, anorectal and urogenital function remain common problems after total mesorectal resection (TME), which seriously decreases the quality of life of patients. Surgical nerve damage is one of the main causes of the complications, while TME with pelvic autonomic nerve preservation is an effective way to reduce the occurrence of adverse outcomes. Intraoperative nerve monitoring (IONM) is a promising method to assist the surgeon to identify and protect the pelvic autonomic nerves. Nevertheless, the monitoring methods and technical standards vary, and the clinical use of IONM is still limited. This review aims to summarize the researches on IONM in rectal and pelvic surgery. The electrical nerve stimulation technique and different methods of IONM in rectal cancer surgery are introduced. Also, the authors discuss the limitations of current researches, including methodological disunity and lack of equipment, then prospect the future direction in this field.

Perirectal fascial anatomy and pelvic autonomic nerve preservation during the transanal total mesorectal excision / 中华胃肠外科杂志

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.

Predicting factors for resumption of spontaneous voiding following nerve-sparing radical hysterectomy / 부인종양

OBJECTIVE: To determine factors affecting voiding recovery on the day of Foley catheter removal (postoperative day 7, POD7) after nerve-sparing radical hysterectomy (NSRH) for early-stage cervical cancer. METHODS: Early-stage cervical cancer patients, who underwent type C1 radical hysterectomy between January 2006 and June 2016 were included. Clinical and pathological data were reviewed. Association between inability to attain adequate voiding function on POD7 and potential predicting factors were evaluated in univariate and multivariate analysis. RESULTS: Of 755 patients, 383 (50.7%) resumed adequate voiding function on POD7 while 372 (49.3%) did not. Tumor size was larger in patients whose voiding function was inadequate (2.5 vs. 2.0 cm, p=0.001). Lengths of resected parametria and adjacent vagina were more extensive in patients with inadequate voiding function (p 4 cm (p 4 cm, postoperative urinary tract infection, and primary surgeon were significantly associated with inability to attain adequate voiding function on POD7. CONCLUSION: Extent of disease represented by tumor size, urinary tract infection as well as individual surgeon's technique independently predict resumption of adequate voiding function on POD7 following NSRH.

Effects of Triptolide on Biological Activity of Sciatic Nerve in Cold Preservation and Nerve Regeneration after Allogeneic Transplantation in Rats / 中国康复理论与实践

@#Objective To investigate the effects of triptolide (T10) on biological activity of sciatic nerve in cold preservation and nerve regeneration after allogeneic transplantation. Methods Cell Counting Kit-8 (CCK-8) was used to test the proliferation of SCs in logarithmic phase in 1×10-6 mol/L, 1×10-7 mol/L, 1×10-8 mol/L and 1×10-9 mol/L of T10 solution. The sciatic nerves from Sprague-Dawley rats were pretreated in 0 mol/L, 1×10-6 mol/L, 1×10-7 mol/L, 1×10-8 mol/L and 1×10-9 mol/L of T10 solution at 4 ℃ or 37 ℃ for 24 hours (n = 6). The expression of nerve growth factor (NGF), glial cell line-derived neurotrophic factor (GDNF) and brain-derived neurotrophic factor (BDNF) was detected with Western blotting. Other sciatic nerve fragments were randomly divided into fresh nerve group (group A, n = 30), DMEM preservation group (group B, n = 30), T10 preservation group (group C, n = 30), T10 pretreatment DMEM preservation group (group D, n = 30) and T10 pretreatment T10 preservation (group E, n = 30), and were stored under 4 ℃ for four weeks. Calcein-AM/PI double staining laser confocal microscope and flow cytometry were used to detect the living cells and dead cells. The expression of the major histocompatibility complex (MHC)-I, MHC-II and intercellular cell adhesion molecule-1 (ICAM-1) was detected with Western blotting. The corresponding sciatic nerves were used to repaire 10 mm defects in Wistar rats (named groups A', B', C', D' and E'), and fresh sciatic nerve from Wistar rats were also used to do it (group F'). Compound muscle action potential (CMAP) and motor nerve conduction velocity (MNCV) were tested 16 weeks after transplantation, and then the grafts were observed for the nerve regeneration. Results SCs proliferated as the controls in the T10 solution with a concentration of 1×10-9 to 1×10-7 mol/L (P > 0.05). The expression of all the neurotrophic factors was more under 37 ℃ than under 4 ℃ in all the concentrations of T10 solution, and it was the most in the concentration of 1×10-8 mol/L whenever under 37 ℃ or 4 ℃ (P < 0.05). After four weeks of cold preservation, compared with groups B, C and D, the living nerve cells were the most in group E, and the expression of MHC-I, MHC-II and ICAM-1 was the least (P < 0.05). CMAP, MNCV and the never regeneration were better in group E' than in groups A', B', C' and D' (P < 0.05). A large number of myelinated nerve fibers were observed in groups E' and F', uniformity in size, wide distribution, and with myelin sheath, compared with those in groups A', B', C' and D'. Conclusion A certain concentration of T10 can induce the sciatic nerve of rats to express neurotrophic factor in vitro, which can improve the biological activity of cold preservation nerves, reduce the immunogenicity, and promote the regeneration of recipient nerve after allogeneic transplantation. It is even better to be pretreated with T10 before cold preservation.

The effect of nerve preservation methods on rat sciatic nerve structures studied with Synchrotron small-angle X-ray scattering (SAXS)

BACKGROUND: Synchrotron small-angle X-ray scattering (SAXS) is a very useful technique for experimental study of the nano-structure of the nervous system of animals. The study was designed to evaluate nerve preservation methods for the measurement of SAXS patterns. METHODS: Normal sciatic nerves extracted from male Sprague- Dawley rats were preserved in saline (N = 2), formalin (N = 2) or liquid nitrogen (N = 2) for 1 day, followed by measurement of SAXS patterns. SAXS patterns of normal sciatic nerves (N = 3) extracted just before the initiation of the experiment were used as controls. The study was carried out using the 4C1 beamline at Pohang Accelerator Laboratory in Korea. Incoming X-rays were monochromatized at 11 keV using a double multilayer (WB4C) monochromator with beam size of approximately 0.5 (V) × 0.8 (H) mm2. The exposure time was set at 60 sec, and 8 to 12 images per sample were acquired at a 0.5 mm interval. RESULTS: The periodic peaks of interfibrillar space between collagen fibrils were undetectable. The periodic peaks of the myelin sheath and collagen fibers were weakly detected or undetected in the nerves preserved in normal saline or formalin. The periodic peaks and intensity of the myelin sheath, collagen fibers, and interfibrillar space between collagens in the nerves preserved in liquid nitrogen were comparable to those of nerves in the ex vivo state. CONCLUSIONS: The study results indicated that preservation of nerves in liquid nitrogen is adequate for measurements with SAXS. However, saline and formalin preservation techniques were inadequate for SAXS measurement.

Basal cell adenoma in the deep portion of the parotid gland: a case report

Basal cell adenoma (BCA) is a rare, benign neoplasm that most frequently arises in the parotid gland. We treated a 54-year-old female patient with BCA that had developed in the deep portion of the left parotid gland. The patient presented with gradual facial swelling with no other symptoms. We performed a total parotidectomy to excise the mass, but we preserved the facial nerve. Histopathology revealed a well-encapsulated mass. The tumor was composed of islands of comparatively uniform, small, dark, basaloid epithelial cells in the stroma. Histologic and immunohistochemical studies concluded that the BCA tumors were mostly trabecular. Postoperatively, there was no facial nerve weakness, and the tumor did not recur during the 24-month follow-up period.

Effect of pelvic autonomic nerve preservation for urinary function and sexual dysfunction after resection of rectal cancer in male patients / 中国综合临床

Objective To investigate the effect of pelvic autonomic nerve preservation (PANP) for urinary function and sexual dysfunction after total mesorectal excision (TME) of rectal cancer in male patients. Methods A total of 147 patients, hospitalized from March 2009 to March 2010,were enrolled into this study and received TME plus PANP combination treatment. The clinical data of these cases were analyzed retrospectively. Results There were no operative deaths. The 0. 5 - 1.0 years follow-up data showed that 9 cases (6. 12% ) had voiding dysfunction, 11 cases (7.48%) had sexual dysfunction, 12 cases ( 8.16% ) had local recurrence. Conclusion TME plus PANP combination treatment can improve the urinary and sexual function,without increasing the postoperative local recurrence rate.

Influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer / 中华消化外科杂志

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.

Management of Thyroid Papillary Carcinoma Invading the Recurrent Laryngeal Nerve / 대한내분비외과학회지

PURPOSE: Invasion of the recurrent laryngeal nerve (RLN) by papillary carcinoma of the thyroid gland is rather infrequent. Tumor excision for this patients with invasion of the RLN has been categorized into two groups on the basis of completeness: (1) Resection of the RLN was required for complete excision, and (2) isolation of the RLN from thyroid cancer was mainly performed by sharp dissection to leave as little tumor as possible. Reconstruction of the nerve after complete tumor resection can be added as a supplementary procedure. This study was designed to analyze the clinical characteristics and surgical treatment of thyroid cancer invading the RLN. METHODS: At the Department of Endocrine Surgery of our hospital, 1,426 patients were diagnosed and operated on for papillary thyroid cancer during 36 months, from December 2004 to December 2006. Among them, 49 patients who revealed invasion of the recurrent laryngeal nerve were retrospectively evaluated for their age, gender, preoperative hoarseness and the operative method, change of their postoperative symptoms, radioiodine ablation, the laryngoscopic findings, recurrence and the prognosis. RESULTS: Of the 49 patients, 10 patients had preoperative hoarseness and 13 patients were treated by complete resection. We tried reconstruction of the recurrent laryngeal nerve with using the hypoglossi-recurrent nerve in one case, and with direct end-to-end anastomosis in two cases. The rest of the 36 patients were treated by shaving resection of thyroid and leaving the RLN intact. CONCLUSION: When a surgeon finds papillary carcinoma infiltrating a recurrent laryngeal nerve, regardless of the preoperative symptoms, preservation of the RLN and removal of as much tumor as possible will offer a good result.

Assessment of Sexual and Voiding Function after Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Male Rectal Cancer Patients

PURPOSE: The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function. METHODS: We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients. RESULTS: There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9+/-5.7 vs 13.7+/-7.0, 240+/-91.9 vs 143+/-78, P0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2+/-5.8 to 9.8+/-5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 8.4+/-4.2 vs. 4.4+/-2.9, 5.8+/-2.9, vs. 4.4+/-2.9, 6.1+/-2.4 vs. 4.8+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors. CONCLUSIONS: TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.

Microsurgical treatment of large acoustic neurinoma and facial nerve preservation / 中国综合临床

Objective To explore the microsurgical technique and results of the large acoustic neurinoma and the facial nerve preservation.Methods 35 cases of large acoustic neurinoma treated microsurgically were analyzed retrospectively.Results Total resection was achieved in 33 patients,subtotal in one patient and partial in one patient.The facial nerve was preserved completely in 32 cases (91.4%).One died postsurgery.Conclusion The application of microsurgical techniques and rational selection of operational approach can remarkably increase the total removal rate and facial nerve preservation rate.

Peservation of Facial Nerve Function after Acoustic Neuroma Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial nerve paralysis is a visible complication following acoustic neuroma surgery. The pro-gnostic factors which predict postoperative facial nerve function after acoustic neuroma surgery were investigated. MATERIALS AND METHODS:Fifty one patients with acoustic neuroma operated with neurotological approaches from March, 1987 to May, 1997 at Seoul national university hospital were studied by retrospective medical record review. Patient groups were divided according to surgical approach which were selected on the basis of tumor location and size as well as the need for hearing preservation. They were also divided according to the extent of tumor, preoperative facial nerve function, and tumor size. Under the House-Brackmann grading system, preservation of facial nerve function for each of the groups was analyzed before the operation, immediately after the operation (7th day), and at the time of last follow up (>12 month). The mean age of patients was 49.3 years, ranging from 29 to 72 years. Spearman Correlation analysis was used for statistical evaluation. RESULTS: The extent of tumor or different surgical approaches of tumor removal, such as translabyrinthine, transotic, middle fossa, and the combined approach, did not influence on facial nerve preservation. Pre-operative and immediate postoperative facial nerve functions as well as tumor size were important prognostic factors in the long term facial nerve function. As the size of tumor increased, the long term postoperative facial nerve function became poor. CONCLUSION: Early diagnosis and surgery are required for small size tumors in order to have good facial nerve function following acoustic neuroma surgery.

TREATMENT OF TOTAL AVULSION THE WHOLE HAND WITH DIGITAL NERVES PRESERVATION AND UPPER ABDOMINAL BAG-SHAPED SKIN FLAP / 解放军医学杂志

The treatment of total avulsion of the hand is somewhat difficult and the result usually not satisfactory. Four cases of such patients were treated from 1983 to 1987. After routine debridement, digital nerves and its surrounding adipose tissue were preserved. An "S" shape skin flap was designed an raised in the contralateral upper abdominal quadrant to cover the injured hand like a bag, so that both sides of the hand were covered. The donor area (12cm2) was directly sutured. Nerve endings might grow into the flaps because of the preservation of digital nerves. Three patients were followed-up for 2 to 6 years, the injured hands regained good pain sensation as well as stereognostic and temperatuer sensations. The function of the hand is satisfactory, but the flap looked bulky and multiple plastic operations were necessary to seperate the fingers.