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首页> 外文期刊>International journal of colorectal disease. >Evaluation of two-dimensional intraoperative neuromonitoring for predicting urinary and anorectal function after rectal cancer surgery
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Evaluation of two-dimensional intraoperative neuromonitoring for predicting urinary and anorectal function after rectal cancer surgery

机译：二维术中神经监测在直肠癌手术后预测尿和肛门直肠功能的评估

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Purpose: The aim of this study was to compare the results of two-dimensional intraoperative neuromonitoring (IONM) with the postoperative urinary and anorectal function of rectal cancer patients. Methods: A consecutive series of 35 patients undergoing low anterior resection were investigated prospectively. IONM was performed with electric stimulations of the pelvic splanchnic nerves under simultaneous manometry of the bladder and electromyography (EMG) of the internal anal sphincter (IAS). Urinary and anorectal function were evaluated preoperatively and at follow-up by standardized questionnaires, digital rectal examination scoring system, and long-term catheterization rate. Results: The rate of postoperative newly developed bladder dysfunction was 17 %. IONM with bladder manometry had a sensitivity of 100 %, specificity of 96 %, positive predictive value of 83 %, negative predictive value of 100 %, and overall accuracy of 97 %, respectively. The proportion of patients with severely impaired anorectal function at follow-up was 8 %. The sensitivity, specificity, and positive and negative predictive values for IONM with EMG of the IAS were, respectively, 100, 96, 67, and 100 % with an accuracy of 96 %. The degree of agreement for IONM with EMG of the IAS was good for anorectal function (k = 0.780) and poor for urinary function (k = 0.119). IONM with bladder manometry yielded a very good degree of agreement for urinary function (k = 0.891) and a fair agreement for anorectal function (k = 0.336). Conclusions: The two-dimensional IONM method is suitable for verification of bladder and IAS innervation. Accurate prediction of urinary and anorectal function necessitates both bladder manometry and EMG of the IAS.
机译：目的：本研究的目的是比较二维术中神经监测（IONM）与直肠癌患者术后尿和肛门直肠功能的结果。方法：前瞻性调查连续35例行低位前切除术的患者。 IONM是在同时进行膀胱测压和内部肛门括约肌（IAS）的肌电图（EMG）的同时用电刺激盆腔内脏神经进行的。术前和随访时通过标准化问卷，数字直肠检查评分系统和长期导管插入率评估尿和肛门直肠功能。结果：术后新发膀胱功能障碍的发生率为17％。带有膀胱测压的IONM的敏感性分别为100％，特异性为96％，阳性预测值为83％，阴性预测值为100％和总体准确性为97％。随访时肛门直肠功能严重受损的患者比例为8％。 IAS的EMG对IONM的敏感性，特异性以及阳性和阴性预测值分别为100％，96％，67％和100％，准确度为96％。 IONM与IAS的EMG的吻合度对肛肠功能有利（k = 0.780），而对尿路功能不利（k = 0.119）。膀胱测压的IONM对尿功能的吻合度非常好（k = 0.891），对肛门直肠功能的吻合程度也很理想（k = 0.336）。结论：二维IONM方法适用于膀胱和IAS神经支配的验证。尿液和肛门直肠功能的准确预测需要膀胱测压和IAS的EMG。

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