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首页> 外文期刊>Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract >Total Mesorectal Excision-Does the Choice of Dissection Technique have an Impact on Pelvic Autonomic Nerve Preservation?
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Total Mesorectal Excision-Does the Choice of Dissection Technique have an Impact on Pelvic Autonomic Nerve Preservation?

机译：全直肠系膜切除术-解剖技术的选择是否会影响盆腔自主神经的保存？

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Background: The aim of this experimental study was to assess the quality of pelvic autonomic nerve preservation of different dissection techniques. Material and Methods: Twelve pigs underwent low anterior rectal resection (LARR) with scissors, ultracision, monopolar diathermy, and waterjet, each in three animals. Assessment of pelvic autonomic nerve preservation was carried out by stimulation of the pelvic splanchnic nerves under electromyography of the internal anal sphincter (IAS). Neurostimulation was performed bilaterally after posterior dissection, after complete mesorectal dissection, and after rectal resection. Results: Stimulation resulted in significantly increased amplitudes of the time-based electromyographic signal of the IAS, confirming nerve preservation. The stimulation results after complete mesorectal dissection showed comparable median amplitude increases for dissection with scissors (10. 34 μV (interquartile range [IQR], 5. 58; 14. 74)) and ultracision (9. 79 μV (IQR, 7. 63; 11. 6)). Lower amplitude increases were observed for monopolar diathermy (4. 47 μV (IQR, 2. 52; 10. 46)) and waterjet (0. 61 μV (IQR, 0. 07; 2. 11)) (p = 0. 038). All animals undergoing dissection with scissors, ultracision, and monopolar diathermy had bilateral positive results. Of three animals undergoing LARR with waterjet, one had bilateral positive results. Two had unilateral negative results, indicating incomplete nerve preservation. Conclusion: Scissors, ultracision, and monopolar diathermy might have comparable nerve-sparing potentials and differed from waterjet.
机译：背景：本实验研究的目的是评估不同解剖技术对盆腔自主神经保存质量的影响。材料和方法：12只猪在3只动物中分别用剪刀，超精密切割，单极透热疗法和水刀进行了低位直肠前切除术（LARR）。通过在肛门内括约肌（IAS）的肌电图下刺激盆腔内脏神经来评估盆腔自主神经的保存情况。后解剖，完全直肠系膜解剖和直肠切除后，双侧进行神经刺激。结果：刺激导致IAS的基于时间的肌电信号幅度大大增加，从而确认了神经的保存。完全的直肠系膜剥离后的刺激结果显示，用剪刀（10. 34μV（四分位间距[IQR]，5。58; 14。74））和超精密切割（9. 79μV（IQR，7。63）进行剥离的中值幅度增加相当。 ; 11. 6））。单极透热（4. 47μV（IQR，2. 52; 10. 46））和水刀（0. 61μV（IQR，0. 07; 2. 11））观察到较低的幅度增加（p = 0.038 ）。所有使用剪刀，超切和单极透热进行解剖的动物均具有双侧阳性结果。在三只接受水刀LARR的动物中，一只具有双侧阳性结果。 2例单方面阴性，表明神经保存不完全。结论：剪刀，超精密切割和单极透热疗法可能具有可比的神经保护潜能，并且不同于水刀。

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