Intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy

doi:10.3877/cma.j.issn.1674-3253.2017.05.013

Abstract

Abstract:

Objective

To study the effect of intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy, and investigate its effect on protection of urinary and sexual functions.

Method

Ninety two patients who underwent radical laparoscopic proctectomy between October 2014 and October 2016 in the Third Affiliated Hospital of Sun Yat-sen University were included prospectively. The experimental group underwent intra-operative electrical nerve stimulation on pelvic autonomic nerve during operation. In contrast, the pelvic autonomic nerve of the control group was assessed visually. Urinary function was evaluated by residual urine volume (RUV), international prostatic symptom score (IPSS) and recatheterization rate. Male erectile function was evaluated using the international index of erectile function (IIEF-5) scale.

Results

Compared with the control group, the experimental group required more operative time [(146±24) min vs (125±28) min, P<0.01], and less deterioration in postoperative RUV [7 days:(32±16) ml vs (52±19) ml, P=0.005]; 1 month: [(26±13) ml vs (40±18) ml, P=0.026], lower IPSS [(7 days: (8±4) vs (12±5), P=0.008; 1 month: (6±3) vs (8±4), P=0.021] and higher IIEF score[3 months: (10.7±2.2) vs (9.3±2.4), P<0.01; 6 months: (15.4±1.8) vs (13.2±2.0), P<0.001].

Conclusion

Intra-operative electrical nerve stimulation is feasible for assessment of pelvic autonomic nerve during radical laparoscopic proctectomy. It is more effective in protection of urinary and male erectile functions.

Key words: Rectal cancer, Laparoscopy, Electrical nerve stimulation, Urinary function, Sexual function

Xueling Zhou, Jiafeng Fang, Lei Cai, Xiaolan He, Yun'e Yang, Jing Su, Shiju Huang, Jie Situ, Zongheng Zheng, Xiaoling Li. Intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(05): 344-348.

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References 25

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组别	例数	年龄（岁，±s）	性别（例）		BMI（kg/m²，±s）	新辅助化疗（例）	肿瘤部位（例）
组别	例数	年龄（岁，±s）	男	女	BMI（kg/m²，±s）	新辅助化疗（例）	高位（8～12 cm）	中低位（<8 cm）
实验组	48	59±6	36	12	21.1±3.2	10	36	12
对照组	44	60±6	31	13	20.5±4.8	8	34	10
统计值	?	t=0.910	χ²=0.240		t=1.482	χ²=0.103	χ²=0.065
P值	?	0.382	0.624		0.102	0.749	0.799
组别	肿瘤大小[cm²，M（Q）]	手术类型		TNM分期			手术时间（min，±s）	出血量（ml，±s）
组别	肿瘤大小[cm²，M（Q）]	LAR（例）	APE（例）	Ⅰ期（例）	Ⅱ期（例）	Ⅲ期（例）	手术时间（min，±s）	出血量（ml，±s）
实验组	9(12.00)	42	6	17	23	8	146±24	30(30.00)
对照组	12(9.75)	40	4	18	20	6	125±28	50(51.25)
统计值	χ²=-1.096	χ²=0.275		χ²=0.715			t=-3.900	χ²=-1.319
P值	0.273	0.600		0.398			<0.001	0.187

组别	例数	年龄（岁，±s）	性别（例）		BMI（kg/m²，±s）	新辅助化疗（例）	肿瘤部位（例）
组别	例数	年龄（岁，±s）	男	女	BMI（kg/m²，±s）	新辅助化疗（例）	高位（8～12 cm）	中低位（<8 cm）
实验组	48	59±6	36	12	21.1±3.2	10	36	12
对照组	44	60±6	31	13	20.5±4.8	8	34	10
统计值	?	t=0.910	χ²=0.240		t=1.482	χ²=0.103	χ²=0.065
P值	?	0.382	0.624		0.102	0.749	0.799
组别	肿瘤大小[cm²，M（Q）]	手术类型		TNM分期			手术时间（min，±s）	出血量（ml，±s）
组别	肿瘤大小[cm²，M（Q）]	LAR（例）	APE（例）	Ⅰ期（例）	Ⅱ期（例）	Ⅲ期（例）	手术时间（min，±s）	出血量（ml，±s）
实验组	9(12.00)	42	6	17	23	8	146±24	30(30.00)
对照组	12(9.75)	40	4	18	20	6	125±28	50(51.25)
统计值	χ²=-1.096	χ²=0.275		χ²=0.715			t=-3.900	χ²=-1.319
P值	0.273	0.600		0.398			<0.001	0.187

分组	RUV（ml，±s）			排尿功能障碍[例（%）]	IPSS（分，±s）				二次导尿率[例（%）]
分组	术前	术后7 d	术后1个月	排尿功能障碍[例（%）]	术前	术后7 d	术后1个月	术后6个月	二次导尿率[例（%）]
实验组	13±7	32±16	26±13	2（4.2%）	2.6±0.3	7.7±4.2	6.1±3.2	5.1±2.1	2（4.2）
对照组	14±7	52±19	40±18	05（11.4%）	2.8±0.4	11.6±5.4	7.8±3.5	5.6±2.2	4（9.1）
统计值	t=0.174	t=5.608	t=4.343	χ²=1.691	t=1.241	t=3.851	t=2.438	t=1.721	χ²=0.913
P值	0.738	0.005	0.026	0.253	0.334	0.008	0.021	0.076	0.421

分组	RUV（ml，±s）			排尿功能障碍[例（%）]	IPSS（分，±s）				二次导尿率[例（%）]
分组	术前	术后7 d	术后1个月	排尿功能障碍[例（%）]	术前	术后7 d	术后1个月	术后6个月	二次导尿率[例（%）]
实验组	13±7	32±16	26±13	2（4.2%）	2.6±0.3	7.7±4.2	6.1±3.2	5.1±2.1	2（4.2）
对照组	14±7	52±19	40±18	05（11.4%）	2.8±0.4	11.6±5.4	7.8±3.5	5.6±2.2	4（9.1）
统计值	t=0.174	t=5.608	t=4.343	χ²=1.691	t=1.241	t=3.851	t=2.438	t=1.721	χ²=0.913
P值	0.738	0.005	0.026	0.253	0.334	0.008	0.021	0.076	0.421

分组	例数	术前	术后3个月	术后6个月
实验组	48	20.6±1.3	10.7±2.2	15.4±1.9
对照组	44	20.8±1.4	9.3±2.4	13.2±2.0
P值	?	0.934	<0.001	<0.001

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