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

<动物实验> 1)严重损伤犬胃下神经长时间自发重建的发生率高，在电生理和组织学上均有表现。神经长度的一半被切断，4年后检查其重建。重建率约60%。2)在犬盆腔神经和结肠神经之间移植胃下神经，尝试盆腔神经到新膀胱的再神经移植。电生理学和组织学显示了该通路的重建。3)利用自主神经重建犬胃下神经与利用躯体神经重建无显著性差异。4)采用人工神经导管（聚乙醇酸-胶原）重建犬胃下神经。电生理学和组织学证实了该通路的重建。5)部分阐明了泌尿生殖器官NO系统随年龄、性激素状况等的变化。<临床应用>根据上述动物实验结果，在临床上应用自主神经重建。1)在100例根治性前列腺切除术中，有28例患者需要腓肠神经重建海绵神经以恢复勃起功能。移植可单侧、双侧或内侧进行。以上三种方法均可观察到勃起功能的恢复。术后平均恢复时间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。观察到射精功能的恢复。3)一种安全、微创、低成本的手术，称为无端口内窥镜手术，被开发出来进行这些神经重建。

<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.