术中电刺激在系统保留盆腔自主神经根治性子宫切除术中的应用及价值  

The application of intraoperative electrical stimulation during systematic nerve-sparing radical hysterectomy.

作　　者：陈春林[1] 郭红霞[1] 刘萍[1] 黄劲松[1] 陆琳[1] 郭玉[1] 刘文[2] 漆松涛[2] 潘速跃[3] 侯光男[3] 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]南方医科大学南方医院神经外科,广东广州510515 [3]南方医科大学南方医院神经内科,广东广州510515

出　　处：《中国实用妇科与产科杂志》2009年第12期906-910,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省科技计划(2009B030801227)

摘　　要：目的评估在系统保留盆腔自主神经的根治性子宫切除术(SNSRH)中应用术中电刺激(IES)技术识别并确认副交感神经通路成功保留的可行性。方法对2008年6月至2009年4月在南方医科大学南方医院妇产科住院的18例宫颈癌及2例子宫内膜癌患者行SNSRH手术,子宫切除后使用cadwell cascade神经监护仪电刺激盆腔内脏神经(PSN)主干根部并同时记录膀胱逼尿肌肌电(EMG)活动,观察患者术后第8天的残余尿量、残余尿量≤50mL的保留尿管时间、排气及排便时间。结果20例患者中,18例在子宫切除后电刺激PSN主干根部成功诱发膀胱逼尿肌产生EMG活动,定义为电刺激阳性,该组患者术后第8天残余尿量平均为(148.83±141.81)mL,残余尿量≤50mL时保留尿管时间为(9.89±2.70)d,排气时间为(60.29±22.73)h,排便时间为(104.29±37.60)h。另2例电刺激PSN主干根部无法诱发膀胱逼尿肌产生EMG活动,定义为电刺激阴性,这2例患者第8天残余尿量分别为580mL和210mL,保留尿管时间分别为19d和25d。结论在SNSRH术中,IES能够确定副交感神经通路是否成功保留,并可以预测患者术后膀胱功能的恢复情况。Objective To evaluate the feasibility for confirming the preservation of the parasymphathetic nerve pathway during systematic nerve-sparing radical hysterectomy （SNSRH） using intraoperative electrical stimulation（IES）. Methods Eighteen patients with cervical cancer and two patients with endometrial carcinoma underwent SNSRH. IES were performed on pelvic splanehnic nerve （PSN） while recording the electromyographyic （EMG） activity of the vesical detrusor using neurological monitoring system. The residual urine at eighth day, the duration of postoperative catheterization, the first exhaust time and stool time were observed. Results Evokable potentials were recorded in 18 out of 20 patients, called IES-positive. Its residual urine at eighth day was （ 148.83 ± 141.81 ） mL. The average duration of postoperative catheterization was （9.89 ± 2.70） days. The first exhaust time and stool time were （60.29 ± 22.73 ） and （ 104. 29 ± 37.60） hours respectively. For the remaining 2 IES-negative patients, the residual urine was 580mL and 210mL. The durations of postoperative catheterization were 19 and 25 days respectively. Conclusion During SNSRH, IES based on the measurement of EMG activity is a useful tool for confirmation of the preservation of the parasymphathetie nerve pathway innervating the bladder and prediction of the postoperative bladder function.

关 键 词：根治性子宫切除术 保留盆腔自主神经 术中电刺激 副交感神经 

分 类 号：R71[医药卫生—妇产科学]