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Reconstruction of the autonomic nerves controlling the pelvic organs and its clinical application

控制盆腔器官的自主神经重建及其临床应用

基本信息

批准号：
14370504
负责人：
KIHARA Kazunori
金额：
$ 8.96万
依托单位：
Tokyo Medical and Dental University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2002
资助国家：
日本
起止时间：
2002 至 2004
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14370504/
关键词：
Autonomic nerve reconstruction pelvic organs 神経再建自立神経臨床応用

项目摘要

<Animal experiments> 1)Spontaneous reconstruction of the seriously injured canine hypogastric nerve over a long period occurred in high rate, electrophysiologically and histologically. A half of the length of the nerve was transected and its reconstruction was examined 4 years later. Reconstruction rate was approximately 60 %. 2)Reinnervation from the pelvic nerve to the neobladder was tried by transplanting the hypogastric nerve between the pelvic nerve and the colonic nerve in the dog. Reconstruction of the pathway was shown electrophysiologically and histologically. 3)Reconstruction of the canine hypogastric nerve by using the autonomic nerve showed no significant difference compared with that by the somatic nerve. 4)The canine hypogastric nerve could be reconstructed by using the artificial nerve conduit (polyglycolic acid-collagen). Reconstruction of the pathway was confirmed electrophysiologically and histologically. 5)Alteration of the NO system in urogenital organs according to aging, different sex-hormonal condition and so on was partly clarified. <Clinical application> Reconstruction of the autonomic nerve was applied clinically based on the results of the animal experiments mentioned above. 1)Reconstruction of the cavernous nerve for the erectile function was performed in radical prostatectomy using the sural nerve in 28 patients who wanted it among 100 patients. Transplantation was performed unilaterally or bilaterally or medially. Return of the erectile function was observed in each of the above 3 methods. Average recovery time was 13.4 months postoperatively. 2)Reconstruction of the splanchnic nerve for the ejaculatory function was performed during retroperitoneal lymph node dissection. Return of the ejaculatory function was observed. 3)A safe, minimary invasive, low cost surgery, named portless endoscopic surgery, was developed to perform these nerve reconstructions.

<Animal experiments>1）犬腹下神经严重损伤后，在电生理和组织学上，长时间自发性重建的发生率高。切断一半长度的神经，并在4年后检查其重建。重建率约为60%。2)在狗的盆神经和结肠神经之间移植腹下神经，尝试盆神经至新膀胱的神经再支配。电生理学和组织学显示了通路的重建。3)用植物神经重建犬腹下神经与用体神经重建犬腹下神经相比，差异无显著性。4)应用聚羟基乙酸-胶原人工神经导管可重建犬腹下神经。电生理学和组织学证实了通路的重建。5)部分阐明了泌尿生殖器官NO系统随年龄、性激素水平等因素的变化。<Clinical application>根据上述动物实验结果，将自主神经重建应用于临床。1)在100例根治性阴茎海绵体切除术中，28例患者采用腓肠神经重建阴茎海绵体神经，以恢复勃起功能。单侧或双侧或内侧进行移植。在上述3种方法中均观察到勃起功能恢复。术后平均恢复时间为13.4个月。2)在腹膜后淋巴结清扫术中重建内脏神经以恢复射精功能。观察到射精功能恢复。3）发展了一种安全、微创、低成本的神经重建手术，称为无端口内窥镜手术。